Evaluation of the efficacy and safety of either or both mirabegron and silodosin, as a medical expulsive therapy for distal ureteric stones.

OBJECTIVE: To evaluate efficacy and safety of either or both silodosin and mirabegron as MET for distal ureteric stones ≤ 10 mm. PATIENTS AND METHODS: This study enrolled a total of 105 patients, aged between 20 and 56 years, diagnosed by single radiopaque distal ureteral stone measuring ≤ 10 mm. The recruitment period spanned from May 2020 to December 2021. The patients were randomly divided into three groups, with each group consisting of 35 participants. Group A received a once-daily dose of 8 mg of silodosin, group B received a once-daily dose of 50 mg of mirabegron, and group C received a combination of both medications. Treatment was administered to all patients until the stone was expelled or for a maximum duration of four weeks. The stone-free rate was determined by analyzing KUB films with or without ultrasonography. RESULTS: The rate of stone expulsion was significantly higher in group C compared to groups A and B (P = 0.04 and P = 0.004, respectively). The mean (standard deviation) time for stone expulsion in groups A, B, and C was 14 ± 2.3 days, 11 ± 3.1 days, and 7 ± 2.2 days, respectively. Group C demonstrated a significantly shorter stone expulsion time compared to groups A and B (P = 0.001 and P = 0.04, respectively). The frequency of renal colic in group C was significantly lower than that in groups A and B, resulting in a reduced requirement for analgesics (P < 0.05). Anejaculation occurred at a significantly higher rate in the silodosin group (73.9%) and combination group (84%) compared to the mirabegron group (P < 0.05). CONCLUSIONS: The findings of this study suggest that both silodosin and mirabegron are effective treatments for the expulsion of lower ureteric stones. Furthermore, the combination of these medications leads to an increased rate of stone expulsion and a reduced duration of expulsion.

Evaluation of the efficacy of sexual intercourse in expulsion of distal ureteric stones.

OBJECTIVE: To evaluate the efficacy of sexual intercourse in expulsion of distal ureteric stones. PATIENTS AND METHODS: The study included 56 patients with distal ureteric or intramural stone. The stones size ranged from 5 to 10 mm and were detected by US, plain X-ray film, and non-enhanced CT. The patients were divided randomly into group A included 28 patients who were advised to do sexual intercourse 3-4 times/week with administration of symptomatic treatment, and group B included 28 patients receiving symptomatic treatment only (control group) and were instructed not to do sexual intercourse or masturbation during the study. Follow-up (4 weeks) was done by plain X-ray, US, and urine analysis every week and by asking the patients about stone passage, time of expulsion, number of colicky attacks, and analgesic injections. RESULTS: Group A patients mean age was 36.5 ± 10.7 years and group B 37.3 ± 12.5 years. Stone expulsion rate, in the first 2 weeks for group A, was 82% (23/28), while in group B 53% (16/28), (P = 0.006). At the fourth week, expulsion rate for group A reached to 89%, but in group B 71.4%. The mean expulsion time was shorter in group A (11.9 ± 4.4 days) than group B (16.2 ± 6.7 days). The number of colicky attacks and analgesics for group A was less than group B. CONCLUSIONS: Practicing sexual intercourse for 3-4 times/week for married male patients with distal ureteric stone (5-10 mm) increases the expulsion rate and decreases the frequency of renal colic and the needs for analgesic.

Long anterior urethral stricture: Reconstruction by dorsally quilted penile skin flap.

OBJECTIVES: We'd like to present our experience in treating long (>5 cm) anterior urethral stricture by penile skin flap as dorsal on-lay in one-stage procedure. PATIENT AND METHODS: Between January 1998 and December 2010, 18 patients (aged from 28-65 years) presented with long urethral stricture, 5.6-13.2 cm, (penile in 6, bulbar in 2, and combined in 10 cases), those were repaired utilizing long penile skin flaps placed as dorsal on-lay flap in one-stage (Orandi flap 6 cm in 6 cases, circular flaps 7-10 cm in 8, and spiral flaps 10-15 cm in 4). Uroflowmetry and RUG were done following catheter removal and at 6 and 12 months. RESULTS: The urethral patency was achieved in 77% of patients. The complications were fistula in 1 patient (5.5%), re-stricture occurred in 3 patients (16.6%) that required visual internal urethrotomy (VIU), and 2 patients (11%) showed curvature on erection that did not interfere with sexual intercourse. Diverticulum (penile urethra) was seen in 1 patient (5.5%) containing stones and was excised surgically. There was penile skin loss in 3 patients (16.6%). All patients completed at least one year follow-up period. CONCLUSION: Free penile skin flaps offer good results (functional and cosmetic) in long anterior urethral stricture. Meticulously fashioned longitudinal, circular or spiral penile skin flaps could bridge urethral defects up to 15 cm long.