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Tamsulosin not effective to hasten smaller ureteral stone passage
Clinical Question
Is tamsulosin effective to aid in the passing of ureteral kidney stones?
Bottom line
In contrast to results of a previous meta-analysis [POEM 190160], this study failed to find a benefit of tamsulosin (Flomax, Alna) on the passage of symptomatic ureteral stones. However, most patients (74%) in this study had smaller (< 5 mm) stones, and this treatment seems to be more effective with larger stones [POEM 18119]. 1b
Reference
Study design: Randomized controlled trial (double-blinded)
Funding: Government
Setting: Emergency department
Synopsis
This study, conducted in 6 emergency departments, enrolled 512 adults, average age 40.6 years, 72.9% men, with a symptomatic urinary stone located in a ureter. The stones had to be less than 9 mm in diameter (by computed tomography) and most (74%) were less than 5 mm. Patients were randomized, using concealed allocation, to receive tamsulosin 0.4 mg daily or placebo for 28 days. Of the 497 patients evaluated, 50% who were treated with tamsulosin and 47% who were treated with placebo had passed the stone by the end of the 4 weeks (P = not significant). Similarly unaffected were the time to stone passage, the percentage of patients needing surgery or hospitalization, time to return to work, or return emergency department visits.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Unfortunately link to the meta-analysis does not work which is too bad. If the point of a meta-analysis is to sum up knowledge to date (and may have included several RCTs) then it is possible that the study reviewed here is an outlier. I have no way to assess this. Obviously someone needs to re-do the meta by including this paper esp if it is a large study compared to others. Then it can be assessed whether this single negative study "alters" the conclusions in the now outdated previous meta. For now I will not change my practice.
The numbers in the study or small. They could have divided the patients with stones of 5 mm or less, which should be passed without instrumentation as one group and those with larger stones as a second group. I would expect that those with larger stones would likely benefit from the tamsulosin to a small degree
Good poem
I used to give Tamsulosin. So stop?
Excellent