Phosphodiesterase 5 Inhibitors (PDE5i) (Sildenafil) as Medical Expulsive Therapy in Distal Ureteral Stones
Status:
Unknown status
Trial end date:
2017-09-01
Target enrollment:
Participant gender:
Summary
Urolithiasis is one of the most common urological diseases. The risk of urolithiasis is
estimated to be between 5% and 12% all over the world with increased incidence in male rather
than female (2:1) respectively . Ureteral stones account for 20% from all urinary tract
stones, more than 70% of the ureteral stones found in the lower third of the ureter . The
incidence of urinary stones has been increasing day by day. Medical expulsive therapy (MET)
of ureteral stones is the investigators' concern in this study. Stone location, size, number,
ureteral spasm, mucosal edema or inflammation and ureteral anatomy are the factors affecting
passage of the ureteral stones. So, MET is based on mechanism that stone passage is
facilitated by the relaxation of ureteral smooth muscle , increasing hydrostatic pressure
proximal to the stone and decreasing exciting edema . There are many oral medication could be
used as MET such as adrenergic blockers, calcium channel blockers, prostaglandin synthesis
inhibitors, glyceryl trinitrate and steroid treatment . Calcium-channel blockers and
adrenergic α-antagonists are the main that has been proposed to enhance stone passage as
expulsive medical therapy. Cyclic nucleotides are degraded by phosphodiesterases enzymes
(PDEs). So using of PDE inhibtors may play role in relaxation of smooth muscle of the ureter.
A study was done for evaluation of three PDE5 inhibtors, sildenafil , vardenafil and
tadalafil, they found that PDE5 inhibitors can reverse the tension of isolated human ureteral
smooth muscle via cGMP-mediated pathways.