Tamsulosin helps pass larger stones

Short Attention Span Summary

Does tamsulosin help or not?
Studies have been back and forth on whether tamsulosin for medical expulsive therapy works or not.  This meta-analysis gives some clarity by pooling 8 RCTs, though there was some heterogeneity.  Stones <5 mm did not benefit from tamsulosin.  Stones 5 - 10mm did benefit, NNT = 5.

Spoon Feed
If you send a patient home for trial of stone passage, only those with larger stones benefit from tamsulosin.  It was safe in the meta-analysis, but keep in mind it could cause orthostatic hypotension as a side effect.


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Abstract

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.

Author information: 

  • 1Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA. Electronic address: ralph.wang@ucsf.edu.
  • 2Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.
  • 3UCSF Medical Library, University of California, San Francisco, San Francisco, CA.
  • 4Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA.
  • 5Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.
  • 6Department of Urology, University of California, San Francisco, San Francisco, CA.

ABSTRACT

STUDY OBJECTIVE: 

Tamsulosin is recommended for patients receiving a diagnosis of a ureteral stone less than 10 mm who do not require immediate urologic intervention. Because of conflicting results from recent meta-analyses and large randomized controlled trials, the efficacy of tamsulosin is unclear. We perform a systematic review and meta-analysis to investigate the effect of tamsulosin on stone passage in patients receiving a diagnosis of ureteral stone.

METHODS: 

MEDLINE, EMBASE, and CENTRAL databases were searched without language restriction through November 2015 for studies assessing the efficacy of tamsulosin and using a double-blind, randomized, controlled trial design. Meta-analysis was conducted with a random-effects model and subgroup analyses were conducted to determine sources of heterogeneity.

RESULTS: 

Eight randomized controlled trials (N=1,384) contained sufficient information for inclusion. The pooled risk of stone passage in the tamsulosin arm was 85% versus 66% in the placebo arm, but substantial heterogeneity existed across trials (I2=80.2%; P<.001). After stratifying of studies by stone size, the meta-analysis of the large stone subgroup (5 to 10 mm; N=514) indicated a benefit of tamsulosin (risk difference=22%; 95% confidence interval 12% to 33%; number needed to treat=5). The meta-analysis of the small stone subgroup (<4 to 5 mm; N=533) indicated no benefit (risk difference=-0.3%; 95% confidence interval -4% to 3%). Neither meta-analysis for the occurrence of dizziness or hypotension showed a significant effect.

CONCLUSION: 

Tamsulosin significantly improves stone passage in patients with larger stones, whereas the effect of tamsulosin is diminished in those with smaller stones, who are likely to pass their stone regardless of treatment.

Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

PMID: 27616037 [PubMed - as supplied by publisher]