Tamsulosin Helps Passage of Kidney Stones 4-10mm in Size

Tamsulosin Facilitates Passage of Ureteral Stones 4–10 mm in Size

Daniel J. Pallin, MD, MPH reviewing Wang RC et al. Ann Emerg Med 2016 Sep 8.

A meta-analysis clarifies this controversial issue.

Prior research has suggested absence of benefit from tamsulosin, an alpha-1A antagonist, for facilitating passage of ureteral stones <10 mm in size (NEJM JW Gen Med Jul 1 2015 and Lancet 2015; 386:341). Now, investigators conducted a systematic review and meta-analysis of randomized controlled trials of tamsulosin, stratifying the results by stone size (<4 mm vs. 4–10 mm).

Eight randomized trials including 1384 participants with stones <10 mm in size met criteria for the meta-analysis. Patients received tamsulosin (0.4 mg daily) or placebo for 21, 28, or 42 days. In pooled analysis, stone passage without urological intervention occurred in 85% of tamsulosin patients versus 66% of placebo patients, for a significant risk difference of 17%. Dizziness and orthostatic hypotension did not occur more frequently in the tamsulosin group. In a preplanned subgroup analysis, the authors found no benefit from tamsulosin for stone passage in patients with stones <4 mm in size (risk difference, 0%), but a substantial benefit for those with stones 4–10 mm in size (risk difference, 22%; number needed to treat, 5).

COMMENT

Renal colic patients with stones measuring 4–10 mm should receive tamsulosin (0.4 mg daily) to facilitate stone passage. Patients with stones <4 mm should not. Stones >10 mm are unlikely to pass without urological intervention, and for these cases physicians should arrange real-time urology consultation or urology evaluation as soon as possible.
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