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Tamsulosin fails to improve ureteral stone passage

Tamsulosin did not increase the rate of ureteral stone passage within 28 days among ED patients with symptomatic stones smaller than 9 mm, according to findings published in JAMA Internal Medicine.

“Current North American and European treatment guidelines support the use of the alpha-blocker tamsulosin as medical expulsive therapy [for urinary stone disease]... However, these guidelines have been called into question by three recent large clinical trials,” Andrew C. Meltzer, MD, from George Washington University School of Medicine and Health Sciences, and colleagues wrote.

Meltzer and colleagues conducted a double-blind, placebo-controlled clinical trial to examine if tamsulosin promotes ureteral stone passage within 28 days among ED patients. The researchers enrolled 512 patients (mean age, 40.6 years) who presented to the ED with a symptomatic urinary stone less than 9 mm in diameter (mean diameter, 3.8 mm) in the ureter. Participants were randomly assigned to receive either 0.4 mg of tamsulosin or matching placebo daily for 28 days.

Results showed that the rate of stone passage was similar among participants in the tamsulosin group and the placebo group (50% vs. 47%; RR = 1.05; 95.8% CI, 0.87-1.27). There was no significant difference between the groups in crossover to open-label tamsulosin, time to stone passage, return to work, use of analgesic medication, hospitalization, surgical intervention and repeated ED visit.

“Although tamsulosin may still play a role in medical expulsive therapy for larger stones, guidelines that recommend tamsulosin for ureteral stones may need to be revised,” Meltzer and colleagues concluded.

In an accompanying editorial, Philipp Dahm, MD, from the University of Minnesota, and John M. Hollingsworth, MD, MS, from the University of Michigan, wrote that they agree with Meltzer and colleagues’ conclusion that the guidelines for medical expulsive therapy for urinary stone disease need to be revisited.

“However, to say tamsulosin has no benefit for ureteral stones up to 9 mm in size may be an overreach, given that nearly three-quarters of patients in their study had ureteral calculi 4 mm or smaller in size,” they wrote. – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.