04 Nov Tamsulosin (Flomax) Improves Passage of Some Kidney Stones
MedicalResearch.com Interview with:
Ralph Wang, MD, MAS
Associate Clinical Professor, Department of Emergency Medicine
University of California, San Francisco
MedicalResearch.com: What is the background for this study?
Response: Medical expulsive therapy, most notably tamsulosin, has been studied extensively to improve stone passage in patients diagnosed with ureteral stone. Prior trials and meta-analyses have identified a benefit. In fact, tamsulosin is
recommended by the American Urologic Association for patients diagnosed with ureteral stones < 10mm that do not require intervention. However, recent well-conducted multi-center randomized trials have not found any improvement in stone passage.
Thus we conducted a systematic review and meta-analysis of all double blinded, placebo controlled randomized trials of tamsulosin to determine whether it improves stone passage.
MedicalResearch.com: What are the main findings?
Response: Our main findings: tamsulosin improves stone passage in distal ureteral stones 5-10mm in size, but does not improve stone passage in smaller stones (><5mm).
This may be in part due to the fact that the majority of smaller stones pass within 30 days.
MedicalResearch.com: What should readers take away from your report?
Response: The main message is that in subjects with large distal stones, tamsulosin increases the rate of stone passage (NNT = 5), and should be prescribed. In 7 of 8 trials, the duration of tamsulosin therapy was 28 days (in the remaining trial, the investigators considered the stone passage endpoint to be 21 days).
It is reasonable to prescribe patients a 28 day supply of tamsulosin and ensure follow-up within that time frame.
In small stones (4mm or less), more than 80% experience stone passage, and tamsulosin did not result in increased stone passage. We feel it is reasonable to avoid prescribing tamsulosin for small stones.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We did not conduct a meta-analysis of other outcomes, such as time to stone passage or pain relief, which could be potential areas of future research. Furthermore, only 1 study included subjects with non-distal ureteral stones. Thus, the effect of tamsulosin on mid-ureteral and proximal stones is unclear.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Ann Emerg Med. 2016 Sep 7. pii: S0196-0644(16)30364-X. doi: 10.1016/j.annemergmed.2016.06.044. [Epub ahead of print]
Effect of Tamsulosin on Stone Passage for Ureteral Stones: A Systematic Review and Meta-analysis.
Wang RC1, Smith-Bindman R2, Whitaker E3, Neilson J4, Allen IE5, Stoller ML6, Fahimi J4.
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