***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES To study the efficacy of alfuzosin compared with tamsulosin in the management of lower ureteral stones . METHODS A total of 102 patients with stones < 1 cm size and located in the lower ureter were enrolled in the present study and r and omized into 3 equal groups . Group 1 patients ( n = 34 ) received 0.4 mg tamsulosin daily , group 2 patients ( n = 34 ) received 10 mg alfuzosin daily , and group 3 patients ( n = 34 ) received placebo ( control group ) . The patients were given 75 mg diclofenac injection intramuscularly on dem and and were followed up for 4 weeks . RESULTS The average stone size for groups 1 , 2 , and 3 was comparable ( 6.17 , 6.70 , and 6.35 mm , respectively ) . Stone expulsion was observed in 28 of 34 patients ( 82.3 % ) in group 1 , 24 of 34 patients ( 70.5 % ) in group 2 , and 12 of 34 patients ( 35.2 % ) in group 3 . The average expulsion time for groups 1 , 2 , and 3 was 12.3 , 14.5 , and 24.5 days , respectively . The results of both study groups ( groups 1 and 2 ) were superior to those in the placebo group ( P = .003 and P = .001 , respectively ) , but the study failed to show any statistically significant differences between tamsulosin and alfuzosin ( P = .25 ) . Alfuzosin was associated with fewer side effects than tamsulosin , especially in terms of retro grade ejaculation . CONCLUSIONS Medical treatment of lower ureteral calculi with tamsulosin and alfuzosin result ed in a significantly increased stone expulsion rate , decreased expulsion time , and a reduced need for analgesic therapy Abstract Objective : To evaluate and compare the efficacy of tamsulosin and alfuzosin as medical expulsive therapy for ureteric stones . Patients and methods : In all , 112 patients with ureteric stones of ⩽10 mm , located along the ureter , were r and omly divided into three groups . In group I , 32 patients received no α-blockers ( controls ) , in group II 40 patients received tamsulosin 0.4 mg daily , and in group III 40 patients received alfuzosin 10 mg daily . All patients were given analgesia and antibiotics when indicated . The follow-up was weekly for 4 weeks . Results :  The mean stone size and age were comparable in the three groups .  The stone expulsion rate was 44 % , 85 % and 75 % in groups I , II and III , respectively . Half of the stones in group II passed within 2 weeks , half in group III passed within 3 weeks , while more than half of the stones in group I did not pass even after 4 weeks . The mean number of painful episodes was 2.45 , 1.38 and 1.64 in groups I , II and III , respectively . The drug-related side-effects reported by patients were mild and transient . Conclusion : The use of tamsulosin or alfuzosin as medical expulsive therapy for ureteric stones in the three sections of the ureter ( upper , middle and lower ) was safe and effective , as shown by the increased overall stone expulsion rate , reduced stone expulsion time and fewer pain episodes . Tamsulosin was associated with a greater rate of stone expulsion than was alfuzosin BACKGROUND Using a selective α-blocker for medical expulsive therapy ( MET ) is a cost-effective treatment approach widely used for ureteral stones . OBJECTIVE To evaluate the efficacy of silodosin , a selective α-1a receptor antagonist , in this setting . DESIGN , SETTING , AND PARTICIPANTS This was a multicenter , phase 2 study conducted in adult patients with a unilateral ureteral calculus of 4 - 10 mm . Of 239 patients in the safety population , six discontinued due to adverse events . INTERVENTION Patients were r and omized 1:1 to receive silodosin 8 mg or placebo for up to 4 wk . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was spontaneous stone passage , analyzed using logistic regression . Secondary outcomes included time to stone passage , emergency room ( ER ) visits , hospital admissions , analgesic use , and incidence and severity of pain . RESULTS AND LIMITATIONS No significant differences between the silodosin and placebo groups were observed for passage rate of all stones ( 52 % vs 44 % , respectively ; p=0.2 ) . However , silodosin achieved a significantly greater rate of distal ureter stone passage  than placebo ( p=0.01 ) . Significant differences were not observed for ER visits , hospital admission , or use of analgesics . The number of patients in the intent-to-treat population was slightly below the calculated sample size ( 232 vs 240 ) and sample sizes were not calculated for subgroup analyses . CONCLUSIONS This is among the first prospect i ve , r and omized , multi-institutional trials to examine the efficacy of a selective α-1a antagonist as MET in patients with ureteral calculi and did not demonstrate a benefit to the entire ureter . However , silodosin was found to be well tolerated and beneficial in facilitating the passage of distal ureteral stones , warranting additional future studies on distal stone elimination . PATIENT SUMMARY In this report , we looked at the efficacy of silodosin for the treatment of ureteral stones . We found that silodosin  increased passage of distal ureteral stones BACKGROUND Recent large high- quality trials have question ed the clinical effectiveness of medical expulsive therapy using tamsulosin  for ureteral stones . OBJECTIVE To evaluate the efficacy and safety of tamsulosin for distal ureteral stones compared with placebo . DESIGN , SETTING , AND PARTICIPANTS We conducted a double-blind , placebo-controlled study of 3296 patients with distal ureteral stones , across 30 centers , to evaluate the efficacy and safety of tamsulosin . INTERVENTION Participants were r and omly assigned ( 1:1 ) into tamsulosin ( 0.4 mg ) or placebo groups for 4 wk . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary end point of analysis was the overall stone expulsion rate , defined as stone expulsion , confirmed by negative findings on computed tomography , over a 28-d surveillance period . Secondary end points included time to stone expulsion , use of analgesics , and incidence of adverse events . RESULTS AND LIMITATIONS Among 3450 patients r and omized between September 1 , 2011 , and August 31 , 2013 , 3296 ( 96 % ) were included in the primary analysis .  Tamsulosin benefits from a higher stone expulsion rate than the placebo ( 86 % vs 79 % ; p<0.001 ) for distal ureteral stones . Subgroup analysis identified a specific benefit of tamsulosin for the treatment of large distal ureteral stones ( > 5 mm ) . Considering the secondary end points , tamsulosin-treated patients reported a shorter time to expulsion ( p<0.001 ) , required lower use of analgesics compared with placebo ( p<0.001 ) , and significantly relieved renal colic ( p<0.001 ) . No differences in the incidence of adverse events were identified between the two groups . CONCLUSIONS Our data suggest that tamsulosin use benefits distal ureteral stones in facilitating stone passage and relieving renal colic . Subgroup analyses find that tamsulosin provides a superior expulsion rate for stones > 5 mm , but no effect for stones ≤5 mm . PATIENT SUMMARY In this report , we looked at the efficacy and safety of tamsulosin for the treatment of distal ureteral stones . We find that tamsulosin significantly facilitates the passage of distal ureteral stones and relieves renal colic BACKGROUND α-Blockers induce selective relaxation of ureteral smooth muscle with subsequent inhibition of ureteral spasms and dilatation of the ureteral lumen . The aim of the study was to evaluate the efficacy and safety of the α-blocker tamsulosin hydrochloride in patients with ureteral colic owing to a distal ureteral stone . METHODS This was a multicenter , placebo-controlled , r and omized , double-blind study . Patients with emergency admission for ureteral colic with a 2- to 7-mm-diameter radio-opaque distal ureteral stone were included in the study . They received tamsulosin ( 0.4 mg/d ) or matching placebo until stone expulsion or day 42 , whichever came first . The main end point was time to stone expulsion between inclusion and day 42 . Sequential statistical analysis was performed using the triangular test . RESULTS A total of 129 patients with acute renal colic were recruited from emergency wards between February 1 , 2002 , and December 8 , 2006 , in 6 French hospitals . Of these 129 r and omized patients ( placebo , 63 ; tamsulosin , 66 ) , 7 were excluded from analyses : 5 for major deviations from inclusion criteria , 1 for stone expulsion before the first treatment administration , and 1 for consent withdrawal . At inclusion , mean ( SD ) stone diameters were 3.2 ( 1.2 ) and 2.9 ( 1.0 ) mm in the placebo and tamsulosin groups , respectively ( P = .23 ) . Expulsion delay distributions during 42 days did not show any difference ( P = .30 ) . The numbers of patients who spontaneously expelled their stone within 42 days were 43 of 61 ( 70.5 % ) and 47 of 61 ( 77.0 % ) in the placebo and tamsulosin groups , respectively ( P = .41 ) . Corresponding delays were 10.1 ( 10.0 ) and 9.6 ( 9.8 ) days ( P = .82 ) . Other secondary end points and tolerance were not different between groups . CONCLUSION Although well tolerated , a daily administration of 0.4 mg of tamsulosin did not accelerate the expulsion of distal ureteral stones in patients with ureteral colic . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00151567 Objectives A prospect i ve , multicenter , r and omized , double-blind , placebo-controlled trial evaluated the effects of naftopidil 75 mg for medical expulsive therapy for a single ureter stone . Material s and methods Patients diagnosed with a ureter stone were prescribed aceclofenac 100 mg or a combined medication of tramadol 37.5 mg and acetaminophen 325 mg . Patients then r and omly received either naftopidil 75 mg or placebo . Primary endpoint was the stone passage rate at 14 days after medication . Results The 150 patients enrolled in 6 institutions r and omly received either naftopidil ( n = 75 ) or placebo ( n = 75 ) . The percentages of ureter stone passed spontaneously 14 days after medication was 60.9 % in the naftopidil group and 53.3 % in the placebo group . Stone-free rates and the total use of analgesics showed no significant differences between the two groups . Stone-free rates at 14 days after medication were decreased when maximal stone size was increased : 39.4 % ( ≥ 5 mm ) , 15.5 % ( ≥ 6 mm ) , and 7.0 % ( ≥ 7 mm ) . Conclusions The use of naftopidil 75 mg once daily was not effective in increasing spontaneous stone passage rates or reducing analgesic use . The maximal stone size < 6 mm and the follow-up for two weeks would be appropriate for applying medical expulsive therapy to patients with a single ureter stone Purpose We evaluated and compared the efficacy of tamsulosin and alfuzosin in the medical treatment of symptomatic , uncomplicated distal ureteral stones . Material s and Methods A total of 87 patients with distal ureteral stones of ≤10 mm were r and omly divided into 3 groups . Group I patients ( n=29 ) received 0.4 mg tamsulosin daily , group II patients ( n=30 ) received 10 mg alfuzosin daily , and group III patients ( n=28 ) were not given tamsulosin or alfuzosin . Patients in all groups received Diclofenac sodium regularly for 1 week and then on dem and . Follow-up was done on a weekly basis for 30 days . Results The mean stone size was comparable in the 3 groups ( 4.97±2.24 , 5.47±2.13 , and 5.39±1.81 mm , respectively ) . The stone expulsion rate was 86.2 % , 76.6 % , and 50 % in groups I , II , and III , respectively . The difference in groups I and II with respect to group III was significant ( p=0.0028 and 0.035 ) . The mean expulsion time for groups I to III was 7.52±7.06 , 8.26±7.34 , and 13.90±6.99 days , respectively . The expulsion time was significantly shorter in groups I and II than in group III ( p=0.0097 and 0.026 ) . Patients taking tamsulosin and alfuzosin had fewer pain attacks than did group III patients (  
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We did not find evidence for possible subgroup effects based on stone location or α-blocker type .
CONCLUSIONS In patients with ureteric stones , α-blockers likely increase stone clearance but probably also slightly increase the risk of major adverse events .
Subgroup analyses suggest that α-blockers may be less effective in smaller ( ≤5 mm ) than larger stones ( > 5 mm )