Naftopidil and tolterodine in the medical expulsive therapy for intramural ureteral stones: a prospective randomized study

We performed a randomized, prospective study to assess the possible role of combined naftopidil and tolterodine for facilitating the spontaneous expulsion of intramural ureteral stones. A total of 76 patients with intramural ureter stones were included in the study from December 2007 to February 2011. Patients were randomized to one of three treatment groups. Group A patients received naftopidil 25 mg/day, group B patients received naftopidil 25 mg/day plus tolterodine 2 mg (twice a day), and group C patients received tolterodine 2 mg (twice a day). Both groups were followed up for 2 weeks. The stone expulsion rate and time and the number of pain episodes were obtained. Subjects rated the urgency associated with each micturition using the Urinary Sensation Scale (USS). Pain descriptions were recorded by the patients using the visual analog scale (VAS). A significant difference was shown for the expulsion rate between the group C and the other two groups (P < 0.001 by log rank test). In groups A, B and C, the mean number of pain episodes was 2.25 ± 0.90, 1.38 ± 1.37 and 1.54 ± 1.18, respectively. The USS score for groups A, B and C at 3 days was 2.32 ± 0.55, 1.4 ± 0.58 and 1.34 ± 0.49, respectively. It was 1.75 ± 0.44, 1.2 ± 0.41 and 1.22 ± 0.42, respectively, at 7 days. On the other hand, a statistically significant difference was found between groups A and B, and groups A and C in relation to the visual analog scale score on days 3 and 7, respectively. Treatment with naftopidil and tolterodine appears to be beneficial in intramural ureteral stones clearance, particularly in the intramural ureter with symptoms of vesical irritability.