Journal of Isfahan Medical School

Journal of Isfahan Medical School

Comparative Evaluation of the Efficacy of Injectable Dexamethasone and Oral Tamsulosin Versus Oral Tamsulosin Alone on Pain Reduction in Ureteral Stones Smaller Than 1 cm: A Double-Blind Randomized Controlled Trial

Document Type : Original Article(s)

Authors
Reza Kazemi 1
Nazanin Omidi 2
Maede Amiryousefi 3
Narjes Saberi 4
1 Department of Urology, Alzahra Hospital, School of Medicine Isfahan University of Medical Sciences, Reproductive Sciences and Sexual Health Research Center, Isfahan, Iran
2 Department of gynecology, Alzahra Hospital, School of Medicine Isfahan University of Medical Sciences, Isfahan, Iran
3 Department of Urology, Alzahra Hospital, School of Medicine Isfahan University of Medical Sciences, Isfahan, Iran
4 Assistant Professor, Department of Urology, Alzahra Hospital, School of Medicine Isfahan University of Medical Sciences, Isfahan, Iran
10.48305/jims.v44.850.0118
Abstract
Background: Distal ureteral stones <10 mm are a frequent cause of emergency urological visits. Medical expulsive therapy (MET) with alpha-blockers such as tamsulosin is commonly used, yet adjunctive anti-inflammatory agents may enhance efficacy. This study evaluated whether adding intramuscular dexamethasone to oral tamsulosin improves stone expulsion outcomes compared to tamsulosin monotherapy.
Methods: In this double-blind, parallel-group randomized controlled trial, 110 adults with symptomatic distal ureteral stones ≤10 mm confirmed by non-contrast CT were randomized 1:1 to receive either oral tamsulosin 0.4 mg daily plus intramuscular dexamethasone 8 mg weekly (intervention group, n = 55) or oral tamsulosin plus intramuscular normal saline placebo (control group, n = 55). Treatment continued for up to 14 days or until stone passage. The primary outcome was stone expulsion rate by day 14. Secondary outcomes included time to expulsion, analgesic use (diclofenac suppositories), emergency department visits, work days lost, and need for lithotripsy.
Findings: A total of 104 patients (52 per group) completed the trial. Stone expulsion occurred in 86.5% of the intervention group versus 65.4% of controls (OR 3.403; 95% CI 1.277–9.069; P = 0.012). Mean time to expulsion was significantly shorter with dexamethasone (2.91 ± 1.56 vs 4.09 ± 1.58 days; P = 0.001). The intervention group required fewer diclofenac suppositories (2.38 ± 1.36 vs 3.42 ± 0.82; p<0.001) and lost fewer work days (2.62 ± 2.05 vs 4.10 ± 2.15; p=0.001). No significant differences were observed in emergency visits (P = 0.872), lithotripsy rates (P = 0.823), or baseline stone size (P = 0.602).
Conclusion: Weekly intramuscular dexamethasone combined with daily oral tamsulosin significantly improved stone expulsion rate, reduced analgesic use, and minimized work absence compared to tamsulosin alone, supporting its role as an enhanced MET strategy for distal ureteral stones <10 mm.
 

Highlights

Reza Kazemi : PubMed, Google Scholar 

Keywords
Dexamethasone, Ureteral Calculi, Medical Expulsive Therapy (MET), Tamsulosin
Adjuvant Therapy, Pain Management, Randomized Controlled Trial

Subjects

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Journal of Isfahan Medical School
Volume 44, Issue 850
2nd Week, April
March and April 2026
Pages 118-123

  • Receive Date 09 February 2026
  • Accept Date 02 June 2026