Written by Clay Smith
This large RCT found tamsulosin was of no benefit for kidney stone passage at 28 days, regardless of size or location.
Why does this matter?
Medical expulsive therapy with tamsulosin is often recommended for patients with renal colic. The problem is, it doesn't work for smaller stones. Here is yet another study to see if tamsulosin helps.
This was a multi-center RCT, aptly called STONE, with about 500 patients randomized to tamsulosin 0.4mg daily or placebo for 28 days. It found that each group had a 50/50 chance of passing the stone at 28 days. Stones up to 9mm were included; mean stone size was 3.8mm. In the analysis of <5mm or >5mm stones, there was no difference in passage for those on tamsulosin in either subgroup. The conclusion of this trial was that tamsulosin doesn't work at all, no matter what size stone is present.
Effect of Tamsulosin on Passage of Symptomatic Ureteral Stones: A Randomized Clinical Trial. JAMA Intern Med. 2018 Jun 18. doi: 10.1001/jamainternmed.2018.2259. [Epub ahead of print]
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Reviewed by Thomas Davis
Anand Swaminathan on REBEL EM has an in depth analysis of this article that is outstanding.