Category: Clinical Stones: Medical Management

MP31-3 - Medical expulsive therapy for symptomatic distal ureter stones: is the combination of bromelain and tamsulosin more effective than tamsulosin alone? Preliminary results of a single centre study.

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective :

To assess the safety and efficacy of the combination of bromelain and tamsulosin compared to tamsulosin alone as medical expulsive therapy (MET) in promoting spontaneous stone passage (SSP) in patients with symptomatic distal ureter stones.


Methods :

From December 2016 to November 2017, 114 patients presented to the Emergency Department (ED) with a single distal ureteral stone with a diameter between 4 and 10 mm were enrolled (Group A). Patients self-administered bromelain (500 mg daily) in association with tamsulosin (0,4 mg daily) for 30 days, or until SSP occurred, or the need of intervention was mandatory. These patients were compared to those from a group extracted from the ED database between December 2015 and November 2016, taking only tamsulosin as MET (Group B) and matched for: sex, age±10%, stone diameter. White blood cell count, creatinine and C-reactive protein levels were compared between groups. The end points were SSP rate, time to expulsion and adverse events of METs.  A subset of cases with larger stones (> 5 mm) was selected and the previous variables were also analyzed.  A logistic regression was applied to model the probability of expulsion using the presence of bromelain and the diameter of the stone as explanatory variables. 


Results :

Characteristics baseline of the study groups are shown in Fig. 1a.


SSP rate was 87.7% vs. 75.4% for group A vs group B, respectively (p = 0.016). Considering larger stones, SSP rate was 83.3% in group A and 61% in group B (p < 0.01) (Fig. 1b). No statistical difference was observed for time to self-reported stone expulsion (11,68 days for group A; 11,57 days for group B; p=0.91). At the same conditions, with each increment in millimeters of the stone diameter the probability of spontaneous expulsion is reduced by 59.1% (p


Conclusions :

When MET for symptomatic distal ureteral stones is considered, the association of bromelain and tamsulosin is safe and increases the probability of SSP compared to tamsulosin alone. This effect is even stronger with larger stones. 

Franco Palmisano

Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Matteo Giulio Spinelli

Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Elisa De Lorenzis

Resident
Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Stefano Paolo Zanetti

Resident
Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Stefano Luzzago

Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Andrea Gallioli

Resident
Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Luca Boeri

Resident
Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milano, Lombardia, Italy

Luca Boeri MD, Resident in Urology, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
I am a III year resident in Urology (chief Prof. Emanuele Montanari). I have been doing research since 4 years. My interests are in minimally invasive surgery, endourology, stone disease, infections, prostate cancer, bladder cancer and andrology.
I am currently attending a 1 year Research Fellowship at Mayo Clinic (Rochester, Minnesota, USA).
Our Department in Milan is a leading center for PCNL, RIRS, UTUC treatment, robotic surgery.

Ilaria Sabatini

Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Matteo Fontana

Resident
Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Gianluca Sampogna

Resident
Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Vito Lorusso

Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Michele Morelli

Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Fabrizio Longo

Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Paolo Guido Dell'Orto

Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Emanuele Montanari

Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy