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Can Tamsulosin Get That STONE to Drop?

For over a decade, calcium channel blockers (i.e. nifedipine) and, more commonly, alpha adrenoreceptor antagonists (i.e. tamsulosin) have been employed in the treatment of ureteral colic for their potential ability to increase stone passage, reduce pain medication use and reduce urologic interventions. These interventions were mostly based on poor methodologic studies and meta-analyses of these flawed studies... Tamsulosin should not routinely be prescribed to patients with ureteral colic and, at this point, it is unclear if there is any subgroup that may benefit. There will be continued conjecture that larger stones may benefit due to inconsistency in the literature and the absence of a RDCT…

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 Tamsulosin for kidney stones: The STONE trial

The results of this trial are not surprising. We have a number of high quality studies on this topic demonstrating the same thing: tamsulosin doesn’t work. All therapies come with harms and costs. When there is no benefit, which seems to be the case with tamsulosin for nephrolithiasis, a therapy should be avoided.

 Tamsulosin – You’ve Lost that Loving Feeling – For Renal Colic

There are many discussions to be had with our Urology colleagues to determine the allocation of resources in the best interests of our patients. The guidelines published by the American Urological Association should also reflect the latest research. In female patients with stones 5-9mm, perhaps Tamsulosin could be used with less risk, but the current literature does not support its routine use. Otherwise, uncomplicated stones <9mm can be treated conservatively.

Articles of Interest

Another Failure for Tamsulosin

As has been described more than once on this blog, the evidence favoring use of tamsulosin for renal colic has been grossly overstated. The vast majority of the trial evidence collated by the Cochrane Review has been distorted by small trials and those biased by pharmaceutical manufacturers. Every time a reasonably-designed randomized-controlled trial has been performed, the magnitude of effect has been dramatically lower – or non-existent.

Does Use of Tamsulosin in Renal Colic Facilitate Stone Passage?

Clearly, there is disagreement in the literature. None of the studies are ideal. We continue to lack a large, RDCT done on patients presenting to the Emergency Department with renal colic. The best evidence we have to date, does not show a significant benefit in the use of tamsulosin in renal colic to facilitate stone passage.

Finally, an End to Tamulosin for Renal Colic?

Most urologic professional societies recommend “medical expulsive therapy” for ureterolithiasis, with an expectation of increased stone expulsion, improved time-to-passage, and reduced need for analgesia. Regardless, the empiric use of tamulosin has simply been an urban legend taken one step too far. Short of large stones in the lower urinary tract, the benefit is fleeting at best – and the magnitude of the benefit may be too low to matter.

Is Flomax (Tamsulosin) effective for treating 4mm ureteral stones, also known as ureterolithiasis?

The effectiveness of Flomax (Tamsulosin) for treating 4mm ureteral stones is a topic of ongoing research and debate...

JC – Tamsulosin and Renal Colic

hat’s more controversial is whether we can aid the passage of a stone using MET (Medical Expulsive Therapy), typically with Tamsulosin or Nifedipine. There was a lot of enthusiasm for this in the past, but the evidence has not really stacked up to be decisive. Although there are meta-analyses and systematic reviews out there that are postive the methodological quality and patient groups have questioned the validity of the recommendations.

Medical Expulsive Therapy (MET) in Renal Colic

MET does not appear to facilitate the passage of kidney stones and should not empirically be used in most patients with ureteric colic. Significant. In many hospitals, use of MET is standard care for patients with ureteric colic. This well-done trial gives excellent evidence that this should not be part of standard treatment.

Tamsulosin for urolithiasis: a review of the recent literature and current controversies

In the United States, urolithiasis affects approximately 1 in 11 people, and there is evidence that the prevalence is increasing. A relatively recent treatment strategy for urolithiasis involves using medical expulsive therapy (MET) to increase the likelihood of spontaneous passage of ureteral stones. The 2 leading drug classes for MET are alpha-1-andrenergic receptor blockers and calcium channel blockers. Tamsulosin, an alpha-1-adrenocepter blocking agent, is thought to induce spontaneous stone passage by relaxing ureteral smooth muscle tone. However, tamsulosin has not been proven effective for increasing ureteral stone passage and is not approved by the Food and Drug Administration for this indication.

Use of Alpha Blockers in Ureteric Colic – Systematic Review + Meta-Analysis

The available high-quality evidence does not show a benefit to alpha blockers in renal colic. There appears to be evidence supporting use only in larger stones. However, this comes with the caveat that to apply this information, we would have to obtain advanced imaging of all patients with ureteric colic which, we know, is not necessary. If you decide to scan a patient and you find a stone < 5 mm, it is unlikely that an alpha blocker is useful. On the other hand, if you find a stone > 5 mm, consideration of adding an alpha blocker to treatment is reasonable.