Background: Urinary stone disease is common, with an estimated prevalence among the general population of 2%
to 3%. Ureteric stones can cause severe pain and have a significant impact on quality of life, accounting for over
15,000 hospital admissions in England annually. Uncomplicated cases of smaller stones in the lower ureter are
traditionally treated expectantly. Those who fail standard care or develop complications undergo active treatment,
such as extracorporeal shock wave lithotripsy or ureteroscopy with stone retrieval. Such interventions are expensive,
require urological expertise and carry a risk of complications.
Growing understanding of ureteric function and pathophysiology has led to the hypothesis that drugs causing
relaxation of ureteric smooth muscle, such as the selective α-blocker tamsulosin and the calcium-channel blocker
nifedipine, can enhance the spontaneous passage of ureteric stones. The use of drugs in augmenting stone
passage, reducing the morbidity and costs associated with ureteric stone disease, is promising. However, the
majority of clinical trials conducted to date have been small, poor to moderate quality and lacking in
comprehensive economic evaluation.
This trial aims to determine the clinical and cost-effectiveness of tamsulosin and nifedipine in the management of
symptomatic urinary stones.