Clinical Question: Is tamsulosin effective in facilitating the ureteral stone expulsion in ED patients presenting with stones < 9 mm in diameter? Show Population: Adults > 18 years of age presenting to the ED with a symptomatic urinary stone determined by computed tomography (CT) to be < 9 m in diameter and located in the ureter. Outcomes:
Intervention: Tamsulosin 0.4 mg q24 Control: Matched placebo Design: Multicenter, randomized, double-blind, placebo-controlled study Excluded: Patients requiring/desiring immediate surgical management, UTI, Prior GU surgery, pregnant patients, breastfeeding mothers, prior tamsulosin hypersensitivity, current use of alpha-blockers or calcium channel blockers, current use of steroids, stone > 9 mm, prior treatment for current ureteral stone, use of vardenafil (contraindication to tamsulosin), known renal insufficiency, fever > 101.5, floppy iris syndrome, planned cataract surgery within 60 days, prisoners, prior enrollment in study Primary Results
Critical Findings:
Strengths:
Limitations:
Discussion:
Authors Conclusions:“Tamsulosin did not significantly increase the stone passage rate compared with placebo. Our findings do not support the use of tamsulosin for symptomatic urinary stones smaller than 9 mm. Guidelines for medical expulsive therapy for urinary stones may need to be revised.” Our Conclusions: We agree with the authors conclusions. This well-done, RDCT did not demonstrate an advantage to medical expulsion therapy with tamsulosin in comparison to placebo at 28 days. Potential to Impact Current Practice: Current urology guidelines recommend the addition of tamuslosin in the treatment of ureteral colic mainly based on poor quality studies and systematic reviews and meta-analyses including these poorly done studies. This study adds to the growing, high-quality evidence that tamsulosin offers no significant benefit and further challenges current practices. Bottom Line: Tamsulosin should not routinely be prescribed to patients with ureteral colic and, at this point, it is unclear if there is any subgroup that may benefit. There will be continued conjecture that larger stones may benefit due to inconsistency in the literature and the absence of a RDCT primarily looking at passage of larger stones. Does tamsulosin dissolve kidney stones?Tamsulosin cleared stones more than calcium channel blockers (6 studies). Tamsulosin 0.4 mg daily was shown to be equally effective to tamsulosin 0.2 mg daily (small study).
How long does tamsulosin take to work for kidney stones?How long it takes can depend on the size and location. With this in mind, Flomax may help a kidney stone pass a few days faster than without medication. If it's been 4 to 6 weeks and the stone still hasn't passed, contact your healthcare provider.
Does tamsulosin help with kidney stone pain?Meta-analyses of multiple randomized controlled trials (RCTs) suggest that an alpha-blocker (tamsulosin) or a calcium channel blocker (nifedipine) can reduce pain and lead to quicker stone passage and a higher rate of eventual stone passage when compared to placebo or observation.
How long does it take for tamsulosin to start working?The effects of the drug can usually be felt within the first 48 hours. Complete urinary relief may take up to two to six weeks. If a 0.4-mg dose is unable to provide relief, your healthcare provider may recommend that you double the dose to 0.8 mg once daily.
|