الفهرس 
Acknowledgement
Physiology of the ureterOnly 14 pages are availabe for public view
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Abstract
Although tamsulosin showed significant efficiency in terms of spontaneous passage of (10-15) lower ureteric stones in adults, it did not decrease the need for operative intervention. Preoperative tamsulosin significantly facilitated ureteral dilations and simplified ureteroscopic management of such lower ureteric calculi. Tamsulosin have limited actual benefit as a medical expulsive therapy in 10-15 mm lower ureteric stones. The ideal duration of preoperative tamsulosin to improve ureteral dilatability needs to be further studied. Larger randomized control trials are still required to refine the results of the current study. Ureterolithiasis is a major health problem representing 20% of all urinary tract stones (103) Renal colic is a common presenting complaint of patients in an emergency department (ED). Prior research demonstrates that most stones will pass spontaneously, and stone passage rates tend to be inversely proportional to stone size. A subset of patients with ureterolithiasis requires operative urologic intervention. This contributes to cost as well as morbidity (104). It has been established that the urinary smooth muscles contain α-adrenergic receptors that facilitate contraction, leading to renal colic and ureteric spasms in the presence of a stone (105, 106). The MET has been investigated since the 1960s as an alternative to operative management for ureterolithiasis. Many drugs have been investigated, including steroids, NSAIDS, calcium-channel blockers, and α antagonist. Of these studied MET, α-blocker use is supported by the American Urologic Association for its MET properties in patients with ureteral calculi less than 10 mm (64). Despite tamsulosin’s α-blocking properties, which seem to make it ideal for MET, there are conflicting data in the literature, and only a paucity of studies are prospective or randomized controlled clinical trials (107). In our study we estimated the efficacy of tamsulosin in expulsion of lower ureteric stones from 10-15 mm and its role in pain and hydronephrosis improvement and the need for ureteral dilatation in scheduled ureteroscopy. It’s a prospective, randomized comparative study carried out in Asyut Urology Hospital .Our study included 80 patients who randomized into two equal groups, 40 patients for each group, one group received tamsulosin and control group received placebo for 2 months. In our study both groups were similar in percentage of gender, median age, stone laterality, median stone length, width, stone radiologic opacity, CT density and degree of hydronephrosis. Some of patients had reported adverse effects, 43% of 40 patients in the tamsulosin group and 35% of 40 in the placebo group .The most common adverse effects reported for tamsulosin vs. placebo were dizziness, and also there was increased ejaculatory dysfunction among men in tamsulosin group. In our study, the adjusted rate of spontaneous ureteral stone passage at the end of the 2 month treatment period for tamsulosin vs. placebo group was 10% vs. 0 and the median time to expulsion were 4.5 weeks. Both groups showed decrease in analgesic need after the first week of treatment but the total analgesic dose over the 2 months treatment period was not significantly different between the 2group There was always aneed for ureteral dilatation in the control group vs. (85,3 %) of the tamsulosin group in patients who need ureteroscopy due to failure of stone passage but this did not affect the rate of stentless ureteroscopy.