Комбинированная терапия тамсулозином и толтеродином ускоряет выведение камней из мочеточника

Adding tolterodine to tamsulosin reduces stone expulsion time and increases the stone expulsion rate compared with tamsulosin alone, a trial finds. Although medical expulsive therapy with a-blockers is standard management of distal ureteral stones, a substantial proportion of patients fail tamsulosin monotherapy. A prospective, randomized, controlled trial tested tolterodine plus tamsulosin vs tamsulosin monotherapy in 120 patients (N=120) with a single distal ureteral stone sized 4 to 10 mm who presented to Imam Reza Hospital during 2022 to 2023. Patients were randomly assigned to receive 0.4 mg tamsulosin once per day plus 2 mg tolterodine twice per day (n=60) or tamsulosin monotherapy (n=60) for up to 4 weeks. All had normal kidney function at baseline. The combination therapy and monotherapy groups had a stone size of 6.6±1.4 and 5.4±1.5 mm, respectively. The cohort was 57-59%  male with a BMI of 25 kg/m 2 and aged a mean 38 years. The trial’s primary outcomes were stone expulsion and time to expulsion. The stone expulsion rate was significantly higher with combination therapy vs monotherapy at 83.3% vs 66.7%  (c 2, 4.67; P =.03) with combination therapy leading to a faster mean expulsion time of 10.5 vs 14.8 days ( P <.001), respectively, Hamed Mohseni-rad, MD, of Ardabil University of Medical Sciences in Ardabil, Iran, reported in World Journal of Urology. A lower proportion of the combination treatment arm required auxiliary procedures at 4 weeks (16.7%) than the monotherapy arm (33.3%; P =.03). Combination therapy recipients also reported lower Visual Analog Scale (VAS) pain scores at weeks 1 (mean, 4.1 vs 5.8; P <.001), 2 (mean, 2.5 vs 4.1; P <.001), 3 (mean, 1.5 vs 2.9; P <.001), and 4 (mean, 0.9 vs 2.1; P <.001) compared with monotherapy recipients, respectively. Over 4 weeks, the combination treatment arm used fewer analgesics (mean, 4.5 tablets) relative to the monotherapy arm (mean, 7.8 tablets; P <.001). The only significant safety signal was a higher rate of dry mouth with combination therapy than monotherapy (16.7% vs 1.7%; P =.005), respectively. This unblinded trial was limited by not including placebo tablets. “These findings suggest that the synergistic action of an alpha-blocker and an anticholinergic agent provides a superior approach to managing distal ureteral calculi, potentially reducing the need for invasive procedures,” according to Dr Mohseni-rad’s team. References: Mohseni-rad H, Geshlaghchayi HI, Iranpour S. Tamsulosin versus tamsulosin plus tolterodine for the treatment of distal ureteral stones. World J Urol. 2026;44(1):621. doi:10.1007/s00345-026-06657-x