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Report by Brook Woolley, Emergency Medicine Resident
Checked by Jeffrey Jones, Research Director
Grand Rapids Medical Education & Research/Michigan State University, Michigan, USA
A short cut review was carried out to establish whether tamsulosin enhances the chances of spontaneous stone expulsion in renal colic. Thirty‐five papers were found using the reported searches, of which two (a meta‐analysis and one further randomised controlled trial) presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are presented in table 33.. It is concluded tamsulosin may be useful during periods of watchful waiting to enhance ureteric stone expulsion.
In [patients presenting to the emergency department with urinary calculi] is [tamsulosin better than conservative therapy] at [promoting spontaneous stone passage]?
A patient presents to the emergency department with a 6 mm calculi in the left distal ureter. You wonder if the use of tamsulosin would improve the chances of spontaneous stone passage.
Medline 1950–July week 4 2007 using the OVID interface: [(exp ureteral obstruction/or exp ureteral calculi/) AND (exp adrenergic alpha‐antagonists/or tamsulosin.mp.)]. LIMIT to human AND English.
The Cochrane Library Issue 3 2007: tamulosin.ti.ab.kw. 135 records, all duplicated in meta‐analysis.
Thirty‐five papers were found, of which 13 papers were relevant to the study question. One paper was a recent meta‐analysis (2007) which included all but one of the relevant randomised controlled trials.
A well designed meta‐analysis reviewed all prospective, randomised controlled clinical trials that used only α‐blockers in the treatment of ureteric stone patients, and included at least one control arm. This meta‐analysis compiled 11 studies meeting these strict criteria and confirms the beneficial effect of this treatment implied by these small individual studies. The majority of the studies used tamsulosin 0.4 mg daily and half of them showed a significant benefit of treatment within 2 weeks.
Medical treatment to promote spontaneous expulsion of ureteric stones may potentially diminish health care expenditures associated with shock wave lithotripsy and ureteroscopy. Tamsulosin's proposed mechanism is selective relaxation of ureteral smooth muscle, with subsequent inhibition of ureteric spasms and dilatation of the ureteric lumen.
Further studies are needed to identify which patients in terms of stone size, location, duration of colic, and degree of impaction and obstruction are most likely to benefit from α‐blocker treatment.
Tamsulosin may be useful during periods of watchful waiting to enhance uretetic stone expulsion.