Assessment of the efficacy of tamsulosin and potassium citrate in promoting spontaneous ureteral stone expulsion.
Evaluación de la eficacia de tamsulosina y citrato de potasio en la promoción de la expulsión espontánea de cálculos ureterales.
Palabras clave:
Tamsulosina, Citrato de Potasio, Cálculos Ureterales, Litotricia p, Expulsión Espontánea
Resumen
Este estudio tuvo como objetivo evaluar la eficacia de la tamsulosina combinada con citrato de potasio para promover la expulsión espontánea de cálculos ureterales de menos de 10 mm. Se realizó un análisis retrospectivo de 100 pacientes ingresados entre enero de 2020 y diciembre de 2023. Los pacientes se dividieron en cuatro grupos: tamsulosina (0,4 mg/día), citrato de potasio (3 g/día), tratamiento combinado (tamsulosina + citrato de potasio) y un grupo de control (solo analgesia + ingesta hídrica regular). Los resultados primarios evaluados durante 4 semanas fueron la tasa y el tiempo de expulsión del cálculo, la ubicación y composición del cálculo, y la seguridad. Los resultados secundarios incluyeron el control del dolor, los indicadores de imagen y de laboratorio y la calidad de vida. Las características basales fueron comparables entre los grupos. El grupo de tratamiento combinado presentó la tasa de expulsión de cálculos más alta, significativamente mayor que la de los grupos de tamsulosina, citrato de potasio y control (p<0,05). La mediana del tiempo de expulsión del cálculo también fue la más corta en el grupo combinado (p<0,05). Las tasas de expulsión de cálculos en el uréter inferior, de ácido úrico y de calcio fueron significativamente más altas en el grupo combinado (p<0,05), mientras que la tasa de expulsión de cálculos superiores no fue estadísticamente significativa (p>0,05). No se registraron eventos adversos graves y los perfiles de seguridad fueron similares en todos los grupos. Los resultados secundarios, incluidos el control del dolor y la calidad de vida, mostraron una mejoría significativa en el grupo combinado en comparación con los demás grupos (p<0,05). La combinación de tamsulosina y citrato de potasio aumenta significativamente la tasa y acorta el tiempo de la expulsión espontánea de cálculos ureterales, con buena seguridad y mejora de la calidad de vida, lo que respalda su valor en la terapia médica expulsiva.
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Hassan MA. Presentation and management outcome of symptomatic epididymal cysts in children: A case series. Int J Surg Open. 2023;55:100626. https://doi.org/10.1016/j.ijso.2023.100626
Hasan A, Kumar V, Kant Kumar S, M M. Radiological and Hematological Parameters Predicting Success of Medical Expulsive Therapy in Patients with Ureteral Calculus. Cureus. 2024;16(8):e67356. https://doi.org/10.7759/cureus.67356.
Ren J. Advances in combination therapy for gastric cancer: integrating targeted agents and immunotherapy. Adv Clin Pharmacol Ther. 2024;1(1):1-15. https://doi.org/10.63623/9k14tf70
Jung HD, Cho KS, Jun DY, Jeong JY, Moon YJ, Chung DY, et al. Silodosin versus Tamsulosin for Medical Expulsive Therapy of Ureteral Stones: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. Medicina (Kaunas). 2022;58(12):1794. https://doi.org/10.3390/medicina58121794.
Hong SH, Jang EB, Hwang HJ, Park SY, Moon HS, Yoon YE. Effect of α1D-adrenoceptor blocker for the reduction of ureteral contractions. Investig Clin Urol. 2023;64(1):82-90. https://doi.org/10.4111/icu.20220254.
Jalali S, Borumandnia N, Basiri A, Nagiee M, Amiri FB, Tavasoli S, et al. A Comparison of Boron Supplement and Tamsulosin as Medical Expulsive Therapy for Urinary Stones After Extracorporeal Shock Wave Lithotripsy: a Randomized Controlled Clinical Trial. Biol Trace Elem Res. 2023;201(11):5126-5133. https://doi.org/10.1007/s12011-023-03597-0.
Ye Z, Zeng G, Yang H, Tang K, Zhang X, Li H, et al. Efficacy and Safety of Tamsulosin in Medical Expulsive Therapy for Distal Ureteral Stones with Renal Colic: A Multicenter, Randomized, Double-blind, Placebo-controlled Trial. Eur Urol. 2018;73(3):385-391. https://doi.org/10.1016/j.eururo.2017.10.033.
Rodriguez-Hesles CA, Alkhatatbeh H, Alonso Bartolomé MB, Valladares Ferreiro CA, Ayllón Blanco HR, Calzas Montalvo C, et al. Urine alkalinization for dissolution of uric acid stones and treatment of other urological diseases with a treatment combining potassium magnesium citrate and theobromine. Arch Ital Urol Androl. 2025;97(1):13824. https://doi.org/10.4081/aiua.2025.13824.
Sun P, Yue J, Lu C, Ji K, Yang R, Lu J, et al. Targeting urinary calcium oxalate crystallization with inulin-type AOFOS from Aspidopterys obcordata Hemsl. for the management of rat urolithiasis. J. Ethnopharmacol.. 2024;329:118149. https://doi.org/10.1016/j.jep.2024.118149.
Maisto M, Schiano E, Luccheo G, Luccheo L, Alfieri E, Piccolo V, et al. Efficacy of a Multicomponent Nutraceutical Formulation for the Prevention and Treatment of Urinary Tract Stones. Int J Mol Sci. 2023;24(9):8316. https://doi.org/10.3390/ijms24098316.
Dogha MM, Sherif IGA, Madney YM, Harb HS, Rabea H. Comparative study between silodosin, tamsulosin, silodosin plus tadalafil, and tamsulosin plus tadalafil as a medical expulsive therapy for lower ureteral stones: a prospective randomized trial. Int Urol Nephrol. 2025;57(6):1827-1833. https://doi.org/10.1007/s11255-024-04356-3.
Belkovsky M, Zogaib GV, Passerotti CC, Artifon ELA, Otoch JP, da Cruz JAS. Tamsulosin vs. Tadalafil as medical expulsive therapy for distal ureteral stones: a systematic review and meta-analysis. Int Braz J Urol. 2023;49(6):668-676. https://doi.org/10.1590/S1677-5538.IBJU.2023.0345.
Ramadhani MZ, Kloping YP, Rahman IA, Yogiswara N, Soebadi MA, Renaldo J. Silodosin as a medical expulsive therapy for distal ureteral stones: A systematic review and meta-analysis. Indian J Urol. 2023;39(1):21-26. https://doi.org/10.4103/iju.iju_115_22.
Selvi I, Baydilli N, Tokmak TT, Akinsal EC, Basar H. CT-related parameters and Framingham score as predictors of spontaneous passage of ureteral stones ≤ 10 mm: results from a prospective, observational, multicenter study. Urolithiasis.2021;49(3):227-237. https://doi.org/10.1007/s00240-020-01214-6.
Abdel-Basir Sayed M, Moeen AM, Saada H, Nassir A, Tayib A, Gadelkareem RA. Mirabegron as a Medical Expulsive Therapy for 5-10 mm Distal Ureteral Stones: A Prospective, Randomized, Comparative Study. Turk J Urol. 2022;48(3):209-214. https://doi.org/10.5152/tud.2022.22014.
Welty J, Geurin MD. Is potassium citrate effective for preventing kidney stone recurrence in patients with calcium-containing stones? Evid Based Pract. 2018;21(1): E11. https://doi.org/10.1097/01.EBP.0000541948.12657.ee
Sinanoglu O, Yildirim S, Suceken FY, Bicaklioglu F, Aydin ME, Uslu M, et al. Bilateral ureteral stones; factors affecting treatment decision. Urolithiasis. 2024;52(1):76. https://doi.org/10.1007/s00240-024-01573-4.
Abdel-Kader MS, Sayed AM, Sayed SM, AbdelRazek M. Evaluation of the efficacy and safety of either or both mirabegron and silodosin, as a medical expulsive therapy for distal ureteric stones. Int. Urol. Nephrol. 2024;56(5):1605-1610. https://doi.org/10.1007/s11255-023-03880-y.
Aghaways I, Bapir R, Siwaily NS, Abdalqadir AM, Said SH, Mustafa AM, et al. Role of inflammatory markers in predicting spontaneous passage of ureteral stones less than 10 mm. Arch Ital Urol Androl. 2024;96(4):12997. https://doi. org/10.4081/aiua.2024.12997.
Papatsoris A, Alba AB, Galán Llopis JA, Musafer MA, Alameedee M, Ather H, et al. Management of urinary stones: state of the art and future perspectives by experts in stone disease. Arch Ital Urol Androl. 2024;96(2):12703. https://doi.org/10.4081/aiua.2024.12703.
Falahatkar S, Akhavan A, Esmaeili S, Amin A, Kazemnezhad E, Jafari A. Efficacy of tamsulosin versus tadalafil as medical expulsive therapy on stone expulsion in patients with distal ureteral stones: A randomized double-blind clinical trial. Int Braz J Urol. 2021;47(5):982-988. https://doi.org/10.1590/S1677-5538.IBJU.2020.1007.
Beilmann M, Adkins K, Boonen HCM, Hewitt P, Hu W, Mader R, et al. Application of new approach methodologies for nonclinical safety assessment of drug candidates. Nat Rev Drug Discov. 2025;24(9):705-725. https://doi.org/10.1038/s41573-025-01182-9.
Alenezi NA, Zanaty F, Hodhod A, El-Gharabawy M, El-Sherif E, Badawy A, et al. The safety of ureteral stenting with the use of potassium citrate for management of renal uric acid stones. Urol Ann. 2020;12(1):37-41. https://doi.org/10.4103/UA.UA_60_19.
Ch’ng LS, Toh CC, Sathiyananthan JR, Malek R. Does alkalinised urine reduce the rate of encrustation in patients with ureteric stents? A randomised controlled study. Int Urol Nephrol. 2022;54(3):509-515. https://doi.org/10.1007/s11255-022-03105-8.
Kachkoul R, Touimi GB, El Mouhri G, El Habbani R, Mohim M, Lahrichi A. Urolithiasis: History, epidemiology, aetiologic factors and management. Malays J Pathol. 2023;45(3):333-352. PMID: 38155376.
Qu LG, Chan G, Gani J. Clinician training level impacts prescribing practices for the conservative management of acute renal colic: a contemporary update. Int Urol Nephrol. 2021;53(4):661-667. https://doi.org/10.1007/s11255-020-02686-6.
El-Gamal O, El-Bendary M, Ragab M, Rasheed M. Role of combined use of potassium citrate and tamsulosin in the management of uric acid distal ureteral calculi. Urol Res. 2012;40(3):219-224. https://doi.org/10.1007/s00240-011-0406-6.
Simmons KE, Nair HR, Phadke M, Motamedinia P, Singh D, Montgomery TA, et al. Risk factors for common kidney stones are correlated with kidney function independent of stone composition. Am J Nephrol. 2023;54(7-8):329-336. https://doi.org/10.1159/000531046.
Moretto S, Saita A, Scoffone CM, Talso M, Somani BK, Traxer O, et al. Ureteral stricture rate after endoscopic treatments for urolithiasis and related risk factors: systematic review and meta-analysis. World J Urol. 2024;42(1):234. https://doi.org/10.1007/s00345-024-04933-2.
Mohammadi A, Rakebi MM, Gholamnezhad M, Ahmadi Pishkuhi M, Aghamir SMK. Does potassium citrate administration change the type and composition of encrusted material on Double-J stent compared to primary stone? Int Urol Nephrol. 2021;53(9):1797-1803. https://doi.org/10.1007/s11255-021-02891-x.
Joshi HB, Johnson H, Pietropaolo A, Raja A, Joyce AD, Somani B, et al. Urinary Stones and Intervention Quality of Life (USIQoL): Development and Validation of a New Core Universal Patient-reported Outcome Measure for Urinary Calculi. Eur Urol Focus. 2022;8(1):283-290. https:// doi.org/10.1016/j.euf.2020.12.011.
Okada T, Hamamoto S, Taguchi K, Okada S, Inoue T, Ando R, et al. Quality of life after urinary stone surgery based on Japanese Wisconsin Stone Quality of Life questionnaire: multicenter analysis from SMART study group. Urolithiasis. 2023;51(1):113. https://doi.org/10.1007/s00240-023-01486-8.
Feng YS, Kohlmann T, Janssen MF, Buchholz I. Psychometric properties of the EQ- 5D-5L: a systematic review of the literature. Qual Life Res. 2021;30(3):647-73. https://doi.org/10.1007/s11136-020-02688-y.
Sawant R, Paret K, Petrillo J, Koenig A, Wolowacz S, Ronquest N, et al. Health state utility estimates for value assessments of novel treatments in Huntington’s disease: a systematic literature review. Health Qual Life Outcomes. 2024;22(1):33. https://doi.org/10.1186/s12955-024-02242-1.
Hassan MA. Presentation and management outcome of symptomatic epididymal cysts in children: A case series. Int J Surg Open. 2023;55:100626. https://doi.org/10.1016/j.ijso.2023.100626
Hasan A, Kumar V, Kant Kumar S, M M. Radiological and Hematological Parameters Predicting Success of Medical Expulsive Therapy in Patients with Ureteral Calculus. Cureus. 2024;16(8):e67356. https://doi.org/10.7759/cureus.67356.
Ren J. Advances in combination therapy for gastric cancer: integrating targeted agents and immunotherapy. Adv Clin Pharmacol Ther. 2024;1(1):1-15. https://doi.org/10.63623/9k14tf70
Jung HD, Cho KS, Jun DY, Jeong JY, Moon YJ, Chung DY, et al. Silodosin versus Tamsulosin for Medical Expulsive Therapy of Ureteral Stones: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. Medicina (Kaunas). 2022;58(12):1794. https://doi.org/10.3390/medicina58121794.
Hong SH, Jang EB, Hwang HJ, Park SY, Moon HS, Yoon YE. Effect of α1D-adrenoceptor blocker for the reduction of ureteral contractions. Investig Clin Urol. 2023;64(1):82-90. https://doi.org/10.4111/icu.20220254.
Jalali S, Borumandnia N, Basiri A, Nagiee M, Amiri FB, Tavasoli S, et al. A Comparison of Boron Supplement and Tamsulosin as Medical Expulsive Therapy for Urinary Stones After Extracorporeal Shock Wave Lithotripsy: a Randomized Controlled Clinical Trial. Biol Trace Elem Res. 2023;201(11):5126-5133. https://doi.org/10.1007/s12011-023-03597-0.
Ye Z, Zeng G, Yang H, Tang K, Zhang X, Li H, et al. Efficacy and Safety of Tamsulosin in Medical Expulsive Therapy for Distal Ureteral Stones with Renal Colic: A Multicenter, Randomized, Double-blind, Placebo-controlled Trial. Eur Urol. 2018;73(3):385-391. https://doi.org/10.1016/j.eururo.2017.10.033.
Rodriguez-Hesles CA, Alkhatatbeh H, Alonso Bartolomé MB, Valladares Ferreiro CA, Ayllón Blanco HR, Calzas Montalvo C, et al. Urine alkalinization for dissolution of uric acid stones and treatment of other urological diseases with a treatment combining potassium magnesium citrate and theobromine. Arch Ital Urol Androl. 2025;97(1):13824. https://doi.org/10.4081/aiua.2025.13824.
Sun P, Yue J, Lu C, Ji K, Yang R, Lu J, et al. Targeting urinary calcium oxalate crystallization with inulin-type AOFOS from Aspidopterys obcordata Hemsl. for the management of rat urolithiasis. J. Ethnopharmacol.. 2024;329:118149. https://doi.org/10.1016/j.jep.2024.118149.
Maisto M, Schiano E, Luccheo G, Luccheo L, Alfieri E, Piccolo V, et al. Efficacy of a Multicomponent Nutraceutical Formulation for the Prevention and Treatment of Urinary Tract Stones. Int J Mol Sci. 2023;24(9):8316. https://doi.org/10.3390/ijms24098316.
Dogha MM, Sherif IGA, Madney YM, Harb HS, Rabea H. Comparative study between silodosin, tamsulosin, silodosin plus tadalafil, and tamsulosin plus tadalafil as a medical expulsive therapy for lower ureteral stones: a prospective randomized trial. Int Urol Nephrol. 2025;57(6):1827-1833. https://doi.org/10.1007/s11255-024-04356-3.
Belkovsky M, Zogaib GV, Passerotti CC, Artifon ELA, Otoch JP, da Cruz JAS. Tamsulosin vs. Tadalafil as medical expulsive therapy for distal ureteral stones: a systematic review and meta-analysis. Int Braz J Urol. 2023;49(6):668-676. https://doi.org/10.1590/S1677-5538.IBJU.2023.0345.
Ramadhani MZ, Kloping YP, Rahman IA, Yogiswara N, Soebadi MA, Renaldo J. Silodosin as a medical expulsive therapy for distal ureteral stones: A systematic review and meta-analysis. Indian J Urol. 2023;39(1):21-26. https://doi.org/10.4103/iju.iju_115_22.
Selvi I, Baydilli N, Tokmak TT, Akinsal EC, Basar H. CT-related parameters and Framingham score as predictors of spontaneous passage of ureteral stones ≤ 10 mm: results from a prospective, observational, multicenter study. Urolithiasis.2021;49(3):227-237. https://doi.org/10.1007/s00240-020-01214-6.
Abdel-Basir Sayed M, Moeen AM, Saada H, Nassir A, Tayib A, Gadelkareem RA. Mirabegron as a Medical Expulsive Therapy for 5-10 mm Distal Ureteral Stones: A Prospective, Randomized, Comparative Study. Turk J Urol. 2022;48(3):209-214. https://doi.org/10.5152/tud.2022.22014.
Welty J, Geurin MD. Is potassium citrate effective for preventing kidney stone recurrence in patients with calcium-containing stones? Evid Based Pract. 2018;21(1): E11. https://doi.org/10.1097/01.EBP.0000541948.12657.ee
Sinanoglu O, Yildirim S, Suceken FY, Bicaklioglu F, Aydin ME, Uslu M, et al. Bilateral ureteral stones; factors affecting treatment decision. Urolithiasis. 2024;52(1):76. https://doi.org/10.1007/s00240-024-01573-4.
Abdel-Kader MS, Sayed AM, Sayed SM, AbdelRazek M. Evaluation of the efficacy and safety of either or both mirabegron and silodosin, as a medical expulsive therapy for distal ureteric stones. Int. Urol. Nephrol. 2024;56(5):1605-1610. https://doi.org/10.1007/s11255-023-03880-y.
Aghaways I, Bapir R, Siwaily NS, Abdalqadir AM, Said SH, Mustafa AM, et al. Role of inflammatory markers in predicting spontaneous passage of ureteral stones less than 10 mm. Arch Ital Urol Androl. 2024;96(4):12997. https://doi. org/10.4081/aiua.2024.12997.
Papatsoris A, Alba AB, Galán Llopis JA, Musafer MA, Alameedee M, Ather H, et al. Management of urinary stones: state of the art and future perspectives by experts in stone disease. Arch Ital Urol Androl. 2024;96(2):12703. https://doi.org/10.4081/aiua.2024.12703.
Falahatkar S, Akhavan A, Esmaeili S, Amin A, Kazemnezhad E, Jafari A. Efficacy of tamsulosin versus tadalafil as medical expulsive therapy on stone expulsion in patients with distal ureteral stones: A randomized double-blind clinical trial. Int Braz J Urol. 2021;47(5):982-988. https://doi.org/10.1590/S1677-5538.IBJU.2020.1007.
Beilmann M, Adkins K, Boonen HCM, Hewitt P, Hu W, Mader R, et al. Application of new approach methodologies for nonclinical safety assessment of drug candidates. Nat Rev Drug Discov. 2025;24(9):705-725. https://doi.org/10.1038/s41573-025-01182-9.
Alenezi NA, Zanaty F, Hodhod A, El-Gharabawy M, El-Sherif E, Badawy A, et al. The safety of ureteral stenting with the use of potassium citrate for management of renal uric acid stones. Urol Ann. 2020;12(1):37-41. https://doi.org/10.4103/UA.UA_60_19.
Ch’ng LS, Toh CC, Sathiyananthan JR, Malek R. Does alkalinised urine reduce the rate of encrustation in patients with ureteric stents? A randomised controlled study. Int Urol Nephrol. 2022;54(3):509-515. https://doi.org/10.1007/s11255-022-03105-8.
Kachkoul R, Touimi GB, El Mouhri G, El Habbani R, Mohim M, Lahrichi A. Urolithiasis: History, epidemiology, aetiologic factors and management. Malays J Pathol. 2023;45(3):333-352. PMID: 38155376.
Qu LG, Chan G, Gani J. Clinician training level impacts prescribing practices for the conservative management of acute renal colic: a contemporary update. Int Urol Nephrol. 2021;53(4):661-667. https://doi.org/10.1007/s11255-020-02686-6.
El-Gamal O, El-Bendary M, Ragab M, Rasheed M. Role of combined use of potassium citrate and tamsulosin in the management of uric acid distal ureteral calculi. Urol Res. 2012;40(3):219-224. https://doi.org/10.1007/s00240-011-0406-6.
Simmons KE, Nair HR, Phadke M, Motamedinia P, Singh D, Montgomery TA, et al. Risk factors for common kidney stones are correlated with kidney function independent of stone composition. Am J Nephrol. 2023;54(7-8):329-336. https://doi.org/10.1159/000531046.
Moretto S, Saita A, Scoffone CM, Talso M, Somani BK, Traxer O, et al. Ureteral stricture rate after endoscopic treatments for urolithiasis and related risk factors: systematic review and meta-analysis. World J Urol. 2024;42(1):234. https://doi.org/10.1007/s00345-024-04933-2.
Mohammadi A, Rakebi MM, Gholamnezhad M, Ahmadi Pishkuhi M, Aghamir SMK. Does potassium citrate administration change the type and composition of encrusted material on Double-J stent compared to primary stone? Int Urol Nephrol. 2021;53(9):1797-1803. https://doi.org/10.1007/s11255-021-02891-x.
Joshi HB, Johnson H, Pietropaolo A, Raja A, Joyce AD, Somani B, et al. Urinary Stones and Intervention Quality of Life (USIQoL): Development and Validation of a New Core Universal Patient-reported Outcome Measure for Urinary Calculi. Eur Urol Focus. 2022;8(1):283-290. https:// doi.org/10.1016/j.euf.2020.12.011.
Okada T, Hamamoto S, Taguchi K, Okada S, Inoue T, Ando R, et al. Quality of life after urinary stone surgery based on Japanese Wisconsin Stone Quality of Life questionnaire: multicenter analysis from SMART study group. Urolithiasis. 2023;51(1):113. https://doi.org/10.1007/s00240-023-01486-8.
Feng YS, Kohlmann T, Janssen MF, Buchholz I. Psychometric properties of the EQ- 5D-5L: a systematic review of the literature. Qual Life Res. 2021;30(3):647-73. https://doi.org/10.1007/s11136-020-02688-y.
Sawant R, Paret K, Petrillo J, Koenig A, Wolowacz S, Ronquest N, et al. Health state utility estimates for value assessments of novel treatments in Huntington’s disease: a systematic literature review. Health Qual Life Outcomes. 2024;22(1):33. https://doi.org/10.1186/s12955-024-02242-1.
Publicado
2026-03-04
Cómo citar
Liu, L., Zhang, K., & Li, D. (2026). Assessment of the efficacy of tamsulosin and potassium citrate in promoting spontaneous ureteral stone expulsion.: Evaluación de la eficacia de tamsulosina y citrato de potasio en la promoción de la expulsión espontánea de cálculos ureterales. Investigación Clínica, 67(1), 30-44. https://doi.org/10.54817/IC.v67n1a03
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