Evaluating Efficacy of Nigella Sativa, Urtica Dioica, and Peganum Harmala Extract Compared with Tamsulosin for Renal and Ureteral Stone Expulsion and Pain Management

Introduction: For the last four decades, lithotripter introduced was a forward-moving step in stone treatment, an opportunity for less invasive stone treatment in many patients. The advancement in mechanical stone removal is, however, accompanied by the high rate of recurrence, severe pain associated with the passage of stone, as well as the variety of complications, prompting continuous search for better treatment modalities that could include chemical and herbal interventions. we aimed to evaluate the efficacy of a combined extract of three herbs, including Nigella sativa, Urtica dioica leaves, and Peganum harmala seeds, on the expulsion and treatment of urinary stones.Methods: Eighty patients over the age of 18 with renal or upper ureteral stones measuring less than 10 mm were enrolled in this randomized clinical trial. The participants were divided into two groups of control, receiving 0.4 mg of tamsulosin nightly for two weeks and the intervention group, receiving 600 mg/day of a hydro alcoholic extract of the three herbs, split into two doses, for the same duration. Follow-up assessments included KUB sonography, and pain severity evaluation utilising the Visual Analogue Scale (VAS).Results: No significant age difference was found between the tamsulosin group and the combined extract group (mean age 41.25 vs. 44.71, P-value=0.69). Pain assessment revealed no significant difference pre-treatment (P-value=0.234). Post-treatment, the combined extract group reported significantly lower pain levels compared to the tamsulosin group ((median VAS score 0.5 vs. 1.5, P-value=0.040). The intervention group also demonstrated a significant reduction in both the number (P-value=0.03) and size (P-value=0.041) of stones compared to control group.Conclusion: The combined extract of Nigella sativa, Urtica dioica, and Peganum harmala significantly reduced pain and facilitated the expulsion of urinary stones, suggesting its potential as an effective option for medical expulsive therapy in patients with renal and upper ureteral stones.