A 34-year-old man presents with acute left loin-to-groin pain. Non-contrast CT confirms a single 6 mm calculus in the distal left ureter with mild proximal hydronephrosis. He is haemodynamically stable, afebrile, and his pain is controlled. In addition to analgesia, which adjunctive therapy is appropriate?
- A Tamsulosin 0.4 mg daily for up to four weeks ✓
- B Immediate extracorporeal shock wave lithotripsy
- C Allopurinol 300 mg daily
- D Potassium citrate supplementation
Correct answer: A. Tamsulosin 0.4 mg daily for up to four weeks
Explanation
Medical expulsive therapy with an alpha-1 blocker such as tamsulosin is recommended for selected distal ureteric calculi of about 5 to 10 mm in patients with controlled pain and no sepsis, as smooth muscle relaxation facilitates passage. Stones under 5 mm generally pass spontaneously and need no MET. Immediate SWL is reserved for failure of conservative measures or unacceptable pain. Allopurinol and potassium citrate are metabolic preventive agents and have no role in acute expulsion.
Reference: Smith's General Urology, 19th ed.
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