Tamsulosin not useful in expulsion of small Ureteral Stones : JAMA

The use of tamsulosin for symptomatic ureteral stones smaller than 9 mm does not significantly increase the stone passage rate, according to a study published in JAMA Internal Medicine. The study found that stone passage rates were 50% in the tamsulosin group and 47% in the placebo group, the difference being non-significant

A study was conducted to determine if tamsulosin promotes the passage of urinary stones within 28 days among emergency department patients.

The researchers conducted a double-blind, placebo-controlled clinical trial in two phases. The first phase from 2008 to 2009 and second phase from 2012 to 2016. Participants were followed for 90 days. The study included 507 adult patients(median age 40.6 years) with an asymptomatic urinary stone in the ureter less than 9 mm in diameter, as demonstrated on computed tomography.

Participants were randomized with either tamsulosin, 0.4 mg, or matching placebo daily for 28 days. The primary outcome was stone passage by the study participants by day 28. Secondary outcomes included crossover to open-label tamsulosin, time to stone passage, return to work, use of analgesic medication, hospitalization, surgical intervention, and repeated emergency department visit for urinary stones.

The results also showed that no benefit of drug treatment was found for any secondary outcomes, including the duration of use of analgesic medication, the time to return to work, and the need for surgery.

The study concluded that compared with placebo, 28-day treatment with tamsulosin was not associated with the increase in the overall stone passage rate or improve a wide range of secondary outcomes in patients who presented to the emergency department with symptomatic ureteral stones less than 9 mm in diameter.

Initial treatment of urinary stone frequently includes administration of α-adrenergic receptor blockers (α-blockers) to promote stone passage, commonly referred to as medical expulsive therapy. Current North American and European treatment guidelines support the use of the α-blocker tamsulosin as medical expulsive therapy, with the most recent rigorous systematic review and meta-analysis concluding that its effectiveness is mainly for larger stones, not smaller stones, because the latter have a high likelihood of passage without any intervention.

The results of the clinical trial have raised questions to revise the guidelines.

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https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2684477