This randomised trial of 120 patients compared tamsulosin alone against tamsulosin plus tolterodine as medical expulsive therapy for distal ureteric stones.
The combination raised the stone expulsion rate from 66.7% to 83.3% (p=0.03) and shortened mean expulsion time from 14.8 to 10.5 days (p<0.001), with lower pain scores and less rescue analgesia. Adverse effects were comparable, with slightly more dry mouth in the combination arm.
The rationale is plausible — an antimuscarinic relaxing the distal ureter and bladder trigone on top of the alpha-blocker — and the effect size is clinically meaningful for a common problem. It is a single small trial, so treat it as promising rather than definitive, but adding tolterodine is a reasonable option for a suitable patient with a distal stone who wants to avoid intervention.
- Expulsion rate 83.3% with tamsulosin + tolterodine vs 66.7% with tamsulosin alone
- Faster passage (10.5 vs 14.8 days) and less pain and rescue analgesia
- Adverse effects comparable; slightly more dry mouth with the combination
- Single trial of 120 patients — promising, not yet definitive
The statistics, in plain English
An expulsion rate of 83.3% versus 66.7% (p=0.03) is a 16-percentage-point absolute gain — roughly a number-needed-to-treat of 6 for one extra stone passed. With only 120 patients the confidence around that figure is wide, so the direction is more trustworthy than the exact size.
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