Urinary Stone Guidelines May Need Revising, Study Suggests

Tamsulosin is likely no more effective than placebo for promoting the passage of symptomatic ureteral stones with a diameter of less than 9 mm, according to a new study.

This finding suggests that current guidelines may need revising, the authors of the study wrote.
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The study, which was performed by Andrew C. Meltzer, MD, of George Washington University’s School of Medicine and Health Sciences, and colleagues, included 512 patients with a symptomatic urinary stone in the ureter of less than 9 mm (mean diameter: 3.8 mm).

Their study was performed in 2 phases: phase 1 took place from 2008 to 2009 at a single US emergency department, and phase 2 occurred from 2012 to 2016 across 6 US emergency departments.

Patients were randomly assigned to treatment with 0.4 mg tamsulosin or placebo daily for 28 days. Follow-up lasted 90 days.

A total of 497 patients were assessed for the primary outcome, which was defined as stone passage based on visualization or capture by the patient by day 28. Secondary outcomes included crossover to open-label tamsulosin, time to stone passage, return to work, hospitalization, and surgical intervention, among others.

Results of the study indicated that there was no significant difference in stone passage rates for tamsulosin-treated participants compared with placebo-treated patients (50% vs 47% passage rate; relative risk 1.05).

Furthermore, no significant between-group differences were observed for any of the secondary outcomes.

“Our findings do not support the use of tamsulosin for symptomatic urinary stones smaller than 9 mm,” the researchers concluded. “Guidelines for medical expulsive therapy for urinary stones may need to be revised.”

—Christina Vogt

Reference:

Meltzer AC, Burrows PK, Wolfson AB, et al. Effect of tamsulosin on passage of symptomatic ureteral stones: a randomized clinical trial [Published online June 18, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.2259