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.
Keywords:
Tamsulosin, Potassium Citrate, Ureteral Calculi, Lithotripsy, Spontaneous Expulsion
Abstract
This study aimed to evaluate the effectiveness of tamsulosin combined with potassium citrate in promoting the spontaneous passage of ureteral stones ≤10 mm. A retrospective analysis was performed on 100 patients admitted between January 2020 and December 2023. Patients were divided into four groups: tamsulosin (0.4 mg/day), potassium citrate (3 g/day), combined treatment (tamsulosin + potassium citrate), and a control group (analgesics only+ regular water intake). Primary outcomes assessed over four weeks included stone passage rate, passage time, stone location and composition, and safety. Secondary outcomes covered pain control, imaging and laboratory indicators, and quality of life. Baseline characteristics were comparable across groups. The combined treatment group showed the highest stone expulsion rate, which was significantly higher than that of the tamsulosin, potassium citrate, and control groups (p<0.05). The median stone expulsion time was also shortest in the combined group (p<0.05). Expulsion rates for lower ureteral stones, uric acid stones, and calcium stones were significantly higher in the combined group (p<0.05), while the rate for upper stones was not statistically significant (p>0.05). No serious adverse events occurred, and safety profiles were similar across all groups. Secondary outcomes, including pain control and quality of life, showed significant improvements in the combined group compared with the other groups (p<0.05). The combination of tamsulosin and potassium citrate significantly increases the rate and shortens the time of spontaneous ureteral stone expulsion, with good safety and improved quality of life, supporting its role in medical expulsive therapy.
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References
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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.
Published
2026-03-04
How to Cite
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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