In a double-blind, placebo-controlled study researchers in China concluded that Medical expulsive therapy (MET) with the alpha blocker tamsulosin improves passage of large distal ureteral stones.The study has been published in European Urology.
Dr. Zhangqun Ye and associates conducted a double-blind, placebo-controlled study to evaluate the efficacy and safety of tamsulosin for distal ureteral stones compared with placebo.The researchers included 3296 patients with distal ureteral stones, across 30 centers in the study.
The investigators found no significant difference between tamsulosin and placebo among patients with 5 mm or smaller stones (88% vs 87%). The incidence of adverse events were similar between the groups.
Among 3450 patients randomized between September 1, 2011, and August 31, 2013, 3296 (96%) were included in the primary analysis. Patients were randomly assigned to receive tamsulosin (0.4 mg) or placebo for 4 weeks.Tamsulosin benefits from a higher stone expulsion rate than the placebo (86% vs 79%; p<0.001) for distal ureteral stones. Subgroup analysis identified a specific benefit of tamsulosin for the treatment of large distal ureteral stones (>5mm).Overall, tamsulosin-treated patients had a significantly higher stone expulsion rate than placebo recipients (86% vs 79%). Considering the secondary end points, tamsulosin-treated patients reported a shorter time to expulsion (p<0.001), required lower use of analgesics compared with placebo (p<0.001), and significantly relieved renal colic (p<0.001). No differences in the incidence of adverse events were identified between the two groups.
In addition, among patients with stones larger than 5 mm, the average expulsion time was significantly shorter in the tamsulosin-treated patients compared with the placebo group (152.5 vs 299.5 hours).
The researchers concluded that tamsulosin use benefits distal ureteral stones in facilitating stone passage and relieving renal colic. Subgroup analyses find that tamsulosin provides a superior expulsion rate for stones >5mm, but no effect for stones ≤5m
“We demonstrated that the use of tamsulosin was safe and clinically effective in patients with distal ureteral stones and renal colic,” the investigators wrote. “A subgroup analysis identified a specific clinical benefit of tamsulosin for expulsion of distal ureteral stones >5 mm. Our findings add to the evidence of tamsulosin as a promising and useful treatment for large distal ureteral stones.”
Investigators used computed tomography (CT) to determine distal ureteral stone location and size and to confirm stone expulsion. Patients underwent weekly CT scans over the 28-day surveillance period of the trial.
Medical expulsive therapy (MET), in particular a-blockers, have been recommended as supportive medication if observational treatment of a ureteral stone was an option.
For further reference log on to : DOI: http://dx.doi.org/10.1016/j.eururo.2017.10.033
Dr. Kamal Kant Kohli
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