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

2025-06-11
Urolithiasis 53(1)
- Ahmed Mahmoud Mohammed Ahmed Elsherief
- Ahmed Mahmoud Riyad
- Emad Abdellah Ali
- Amr Alam-Eldin Ahmed
- Hassan Ali Gad
- Ahmed Mamdouh Abd Elhameid

PubMed: 40498114
DOI: 10.1007/s00240-025-01768-3

Study Design

Type: Randomized Controlled Trial (RCT)
Sample size: n = 162
Population: 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
Methods: Prospective, randomized controlled study, 1000 mg L-arginine once daily vs tamsulosin 0.4 mg once daily vs placebo
Duration: 4 weeks

Large Human 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.

Research Insights

L-Arginine→Improved Imaging Findings
There was a highly statistically significant difference between the studied groups regarding ultrasound (U/S) and plain urinary tract (PUT) findings after 4 weeks.
Effect
Beneficial
Effect size
Small
Dose
1000 mg once daily
L-Arginine→Increased Spontaneous Stone Expulsion Rate
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).
Effect
Beneficial
Effect size
Large
Dose
1000 mg once daily
L-Arginine→Reduced Colic
There was no statistically significant difference between the groups regarding the number of daily colic episodes and total analgesic dosage required.
Effect
Neutral
Effect size
Small
Dose
1000 mg once daily
L-Arginine→Reduced Hydronephrosis
However, a statistically significant difference was noted regarding stone density and hydronephrosis.
Effect
Beneficial
Effect size
Small
Dose
1000 mg once daily
L-Arginine→Reduced Kidney Stone Density
However, a statistically significant difference was noted regarding stone density and hydronephrosis.
Effect
Beneficial
Effect size
Small
Dose
1000 mg once daily
L-Arginine→Reduced Stone Expulsion Time
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).
Effect
Beneficial
Effect size
Small
Dose
1000 mg once daily
L-Arginine→Reduced Total Analgesic Dosage
There was no statistically significant difference between the groups regarding the number of daily colic episodes and total analgesic dosage required.
Effect
Neutral
Effect size
Small
Dose
1000 mg once daily