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JAMA Intern Med. 2018 Aug 1;178(8):1051-1057. doi: 10.1001/jamainternmed.2018.2259.

Effect of Tamsulosin on Passage of Symptomatic Ureteral Stones: A Randomized Clinical Trial.

Author information

1
Department of Emergency Medicine, George Washington University School of Medicine & Health Sciences, Washington, DC.
2
The George Washington University Biostatistics Center, Washington, DC.
3
Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
4
Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
5
Department of Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham.
6
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
7
Department of Urology, George Washington University School of Medicine & Health Sciences, Washington, DC.
8
Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
9
National Institute of General Medical Sciences, National Institutes of Health, Bethesda, Maryland.

Abstract

Importance:

Urinary stone disease is a common presentation in the emergency department, and α-adrenergic receptor blockers, such as tamsulosin, are commonly used to facilitate stone passage.

Objective:

To determine if tamsulosin promotes the passage of urinary stones within 28 days among emergency department patients.

Design, Setting, and Participants:

We conducted a double-blind, placebo-controlled clinical trial from 2008 to 2009 (first phase) and then from 2012 to 2016 (second phase). Participants were followed for 90 days. The first phase was conducted at a single US emergency department; the second phase was conducted at 6 US emergency departments. Adult patients were eligible to participate if they presented with a symptomatic urinary stone in the ureter less than 9 mm in diameter, as demonstrated on computed tomography.

Interventions:

Participants were randomized to treatment with either tamsulosin, 0.4 mg, or matching placebo daily for 28 days.

Main Outcomes and Measures:

The primary outcome was stone passage based on visualization or capture by the study participant 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.

Results:

The mean age of 512 participants randomized to tamsulosin or placebo was 40.6 years (range, 18-74 years), 139 (27.1%) were female, and 110 (22.8%) were nonwhite. The mean (SD) diameter of the urinary stones was 3.8 (1.4) mm. Four hundred ninety-seven patients were evaluated for the primary outcome. Stone passage rates were 50% in the tamsulosin group and 47% in the placebo group (relative risk, 1.05; 95.8% CI, 0.87-1.27; P = .60), a nonsignificant difference. None of the secondary outcomes were significantly different. All analyses were performed according to the intention-to-treat principle, although patients lost to follow-up before stone passage were excluded from the analysis of final outcome.

Conclusions and Relevance:

Tamsulosin did not significantly increase the stone passage rate compared with placebo. Our findings do not support the use of tamsulosin for symptomatic urinary stones smaller than 9 mm. Guidelines for medical expulsive therapy for urinary stones may need to be revised.

Trial Registration:

ClinicalTrials.gov Identifier: NCT00382265.

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