UroToday - Further proof that tamsulosin works for improving the passage of distal ureteral stones is provided in this randomized study of 100 patients, taking either a placebo or 0.4 mg of tamsulosin for upwards of 4 weeks or until stone passage. The stones were 10 mm or smaller; the average stone size in the tamsulosin group was 5.9 mm vs. 6.0 mm in the control group (p = 0.75).

All of the stones were located below the common iliac vessels. In the tamsulosin group, 82% expelled their stone while in the placebo group this occurred in only 61% (p = 0.02). In addition, in the tamsulosin group stone expulsion occurred sooner (6.4 vs. 9.9 days) and the occurrence of pain episodes (1.6 vs. 2.3 p= 0.02) as well as the need for an analgesic injection (0.9 vs. 1.8 p = 0.001) and the total amount of analgesics used (diclofenac - 68 vs. 127 p = 0.001) were both less in the tamsulosin group.

Of note, in the tamsulosin group, small stones (i.e. < /= 5 mm) passed in 96% of patients, while stones in the 6-10 mm range passed in 69% of patients. No patients stopped the tamsulosin due to side effects during the study.

To my mind, the use of tamsulosin should be a standard of care when dealing with patients presenting with a distal ureteral stone 10 mm or smaller in size. The combination of markedly improved expeditious stone passage coupled with less pain and less need for analgesics makes this therapy a first line treatment and one that really needs to become commonplace in emergency rooms throughout the country.

Al-Ansari A, Al-Naimi A, Alobaidy A, Assadiq K, Azmi MD, Shokeir AA
Urology. 2010 Jan;75(1):4-7
10.1016/j.urology.2009.09.073

UroToday Medical Editor Ralph V. Clayman, MD

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