L. Borghi et al., NIFEDIPINE AND METHYLPREDNISOLONE IN FACILITATING URETERAL STONE PASSAGE - A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY, The Journal of urology, 152(4), 1994, pp. 1095-1098
Expulsive medical therapy of ureteral stones is not well established.
To test the efficacy of a calcium antagonist (nifedipine) associated w
ith a corticosteroid (methylprednisolone) in facilitating ureteral sto
ne passage, we studied 86 patients with a unilateral ureteral radiopaq
ue stone not larger than 15 mm. in maximum diameter, confirmed in each
case by drop excretory urography. Patients were randomly treated for
a maximum of 45 days under double-blind conditions with 16 mg. methylp
rednisolone plus 40 mg. nifedipine daily (group 1-13 women and 30 men,
mean age 45 +/- 14 years, standard deviation) and with 16 mg. methylp
rednisolone plus placebo daily (group 2-18 women and 25 men, mean age
43 +/- 14 years). All patients also received 2 l. of low mineral conte
nt water daily. The average maximum diameter of the stones was 6.7 +/-
3.0 mm. in group 1 and 6.8 +/- 2.9 mm. in group 2 (not significant).
Partial ureteral obstruction was present in approximately half of the
patients in both groups. Four patients in group 1 and 6 in group 2 dro
pped out of the study. In group 1, 34 patients had successful results
(stone passage without surgical manipulation) and 5 failed (success ra
te 87%), compared to 24 and 13, respectively, in group 2 (success rate
65%). This difference was significant (p = 0.021, Fisher's exact test
). No difference was present in the maximum stone diameter among the s
uccessful cases in groups 1 and 2 (6.4 +/- 2.8 and 5.3 +/- 2.2 mm., re
spectively, not significant). In both groups the maximum diameter of t
he stone was larger in the failed than in the successful cases (group
1-10.4 +/- 3.0 versus 6.4 +/- 2.8 mm., p = 0.005, and group 2-9.3 +/-
2.5 versus 5.3 +/- 2.2 mm., p = 0.0001). In group 1 the mean interval
for stone passage in the successful cases was 11.2 +/- 7.5 days, compa
red to 16.4 +/- 11.0 days in group 2 (p 0.036, Student's t test). We c
onclude that nifedipine associated with methylprednisolone is effectiv
e in facilitating ureteral stone passage.