L-arginine role for stone lower ureter: A randomized controlled trial

This study aims to evaluate the effects of L-arginine 1000 mg once daily as a medical expulsive therapy (MET) for lower ureteral stones. This prospective, randomized controlled study was conducted on 162 patients with ureteral stones; 9 patients were excluded due to loss to follow-up, and the remaining 153 patients were divided into three groups. Group I (control) included 51 patients who received a placebo. Group II included 51 patients who received 1000 mg of L-arginine once daily. Group III included 51 patients who received tamsulosin 0.4 mg once daily. There was a highly statistically significant difference between the studied groups regarding ultrasound (U/S) and plain urinary tract (PUT) findings after 4 weeks. Spontaneous stone expulsion rates (SER) in the control, L-arginine, and tamsulosin groups were 6 (11.8%), 48 (94.1%), and 16 (31.4%), respectively (p < 0.001). The mean ± SD of stone expulsion time in the control, L-arginine, and tamsulosin groups was 19.6 ± 5.85, 19.02 ± 5, and 20.58 ± 5.78 days, respectively (p < 0.001). There was no statistically significant difference between the groups regarding the number of daily colic episodes and total analgesic dosage required. However, a statistically significant difference was noted regarding stone density and hydronephrosis. It is concluded that L-arginine is more effective than tamsulosin in increasing the SER and reducing stone expulsion time, with better pain control, making it a safe and effective MET for ureteral stones.