Clinical Question

Is tamsulosin (Flomax) effective in the management of distal ureteric stones?

Bottom Line

Tamsulosin promotes stone passage of ureteric stones that are 5 to 10 mm. Five patients would need to be treated with tamsulosin to cause the expulsion of one such stone. Stones smaller than 5 mm have a high rate of spontaneous passage without any intervention. (Level of Evidence = 1b −)

Synopsis

These authors recruited adult patients who presented to the emergency department with symptoms and imaging consistent with distal ureteric stones. Patients with fever, hypotension, stones larger than 10 mm, or kidney disease were excluded. Using concealed allocation, the investigators randomized the patients to receive tamsulosin, 0.4 mg daily, or matching placebo for 28 days or until stone passage. The two groups had similar baseline characteristics and analysis was by intention to treat. The primary outcome was stone expulsion as confirmed by computed tomography, and time to stone expulsion was defined by self-reported passage of stone or 48-hour pain-free period. Compliance with the study medications was poor in both groups, and almost one-fifth of the patients did not have follow-up imaging. Of the approximately 80% of patients in each group who underwent follow-up computed tomography, there was no difference in the percentage of patients with passed stones (87% in the tamsulosin group vs. 82% in the placebo group; P = .22). In the subset of patients with larger stones (5 to 10 mm), the tamsulosin group had a significantly higher rate of stone passage than the placebo group (83% vs. 61%; P = .03). There were no significant differences detected in time to stone passage, pain, analgesia requirements, need for urologic intervention, or adverse events.

Study design: Randomized controlled trial (double-blinded)

Funding source: Foundation

Allocation: Concealed

Setting: Outpatient (primary care)

Reference: FurykJSChuKBanksCet alDistal ureteric stones and tamsulosin: a double-blind, placebo-controlled, randomized, multicenter trial. Ann Emerg Med2016; 67( 1): 86– 95.