Medical Expulsive Treatment of Distal-Ureteral Stones Using Tamsulosin: A Single-Center Experience

Department of Urology, Second University, Naples, Italy.
Journal of Endourology (Impact Factor: 1.71). 02/2006; 20(1):12-6. DOI: 10.1089/end.2006.20.12
Source: PubMed


To evaluate the efficacy of the addition of tamsulosin to our standard expulsive pharmacologic therapy for the treatment of distal-ureteral stones.
A series of 96 patients referred to our department for the management of symptomatic distal-ureteral calculi were randomly divided into group 1 (N = 46) who received diclofenac (100 mg/daily) plus aescin (80 mg/daily) and group 2 (N = 50) who received the same therapy plus tamsulosin (0.4 mg/daily) for a maximum of 2 weeks. There were no differences between the groups with respect to age, sex, or stone size. The primary endpoint was the expulsion rate. Expulsion time, need for analgesics, need for hospitalization, and drug side effects were the secondary endpoints.
The expulsion rate was significantly higher in group 2 (90%) than in group 1 (58.7%; P = 0.01), and group 2 achieved stone passage in a shorter time (mean 4.4 v 7.5 days, respectively; P = 0.005). Lower analgesic use was found in group 2 (P = 0.003), as well as significantly fewer hospitalizations for recurrent colic (P = 0.01). Both groups experienced few side effects associated with expulsive therapy.
A conservative approach should be considered as an option in the management of uncomplicated distal-ureteral stones. Even if the best pharmacologic expulsive regimen remains to be established, the use of the selective alpha-blocker tamsulosin is recommended in this setting.

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    • "De Sio et al published a study of 96 patients with distal ureteral stones to test the efficacy of tamsulosin as a medical expulsive therapy and found that patients taking tamsulosin achieved significantly higher rates of stone passage (90%) over a shorter time period (4.4 days) [17]. They also had lower analgesic use and fewer hospitalizations. "
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    ABSTRACT: We evaluated and compared the efficacy of tamsulosin and alfuzosin in the medical treatment of symptomatic, uncomplicated distal ureteral stones. A total of 87 patients with distal ureteral stones of </=10 mm were randomly divided into 3 groups. Group I patients (n=29) received 0.4 mg tamsulosin daily, group II patients (n=30) received 10 mg alfuzosin daily, and group III patients (n=28) were not given tamsulosin or alfuzosin. Patients in all groups received Diclofenac sodium regularly for 1 week and then on demand. Follow-up was done on a weekly basis for 30 days. The mean stone size was comparable in the 3 groups (4.97+/-2.24, 5.47+/-2.13, and 5.39+/-1.81 mm, respectively). The stone expulsion rate was 86.2%, 76.6%, and 50% in groups I, II, and III, respectively. The difference in groups I and II with respect to group III was significant (p=0.0028 and 0.035). The mean expulsion time for groups I to III was 7.52+/-7.06, 8.26+/-7.34, and 13.90+/-6.99 days, respectively. The expulsion time was significantly shorter in groups I and II than in group III (p=0.0097 and 0.026). Patients taking tamsulosin and alfuzosin had fewer pain attacks than did group III patients (1.24+/-0.57 vs. 1.43+/-0.67 vs. 1.75+/-1.17). Only 3 cases of drug side effects, 2 in group I and 1 in group II, were recorded. The use of tamsulosin or alfuzosin for the medical treatment of lower ureteric stones proved to be safe and effective. Moreover, tamsulosin did not have any significant benefits over alfuzosin.
    Full-text · Article · Mar 2010 · Korean journal of urology
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    • "Recent studies suggest that α-blockade may be useful in the treatment of ureterolithiasis by increasing the success of stone passage and decreasing the time to stone passage by causing smooth muscle relaxation in the ureter [1] [2] [3] [4] [5] [6] [7] [8]. The use of medications such as α-blockers to improve stone passage, termed medical expulsive therapy, has been evaluated in 2 recent meta-analyses that suggest that α-blockade improves the likelihood of stone passage, with a number needed to treat of only 3.3 in one study and 4 in another [9] [10]. "
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    ABSTRACT: We sought to determine how frequently tamsulosin is used by emergency physicians (EPs) for the treatment of patients with ureteral stones, and examine factors influencing its use. We distributed online and paper surveys to 240 EPs in five states in the United States. Surveys asked the length of time in practice, the type of hospital setting, and the self-reported frequency of tamsulosin use by quartile. A total of 103 EPs (43%) responded to the survey. The majority (60%, 95% CI 51% to 69%) reported the use of tamsulosin in fewer than 25% of patients presenting with ureteral stones, and many (27%, 95% CI 20% to 36%) had not heard of the use of tamsulosin for urinary-stone passage. Practice in a county hospital was associated with infrequent tamsulosin use (p=.02). Despite evidence that alpha-blockade may be beneficial to patients presenting to the emergency department with ureteral stones, this approach is still used inconsistently by EPs.
    Full-text · Article · Oct 2009 · The American journal of emergency medicine
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    • "The patient, the attending urologist, and the investigators were not aware of study arm assignments until the final assessment of outcome. Sample-size calculation was performed based on previous reports of spontaneous stone expulsion and assumed a clinically relevant difference in expulsion rate of 25% [13] [16] [17] [20]. The stone expulsion rate was estimated to be 90% and 65% for patients with and without tamsulosin medication, respectively. "
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    ABSTRACT: Numerous randomised trials have confirmed the efficacy of medical expulsive therapy with tamsulosin in patients with distal ureteral stones; however, to date, no randomised, double-blind, placebo-controlled trials have been performed. The objective of this trial was to evaluate the efficacy of medical expulsive therapy with tamsulosin in a randomised, double-blind, placebo-controlled setting. Patients presenting with single distal ureteral stones < or = 7 mm were included in this trial. Patients were randomised in a double-blind fashion to receive either tamsulosin or placebo for 21 d. The medication was discontinued after either stone expulsion or intervention. Abdominal computed tomography was performed to assess the initial and final stone status. MEASUREMENTS AND LIMITATIONS: The primary end point was the stone expulsion rate. Secondary end points were time to stone passage, the amount of analgesic required, the maximum daily pain score, safety of the therapy, and the intervention rate. Ten of 100 randomised patients were excluded from the analysis. No statistically significant differences in patient characteristics and stone size (median: 4.1 mm [tamsulosin arm] vs 3.8 mm [placebo arm], p=0.3) were found between the two treatment arms. The stone expulsion rate was not significantly different between the tamsulosin arm (86.7%) and the placebo arm (88.9%; p=1.0). Median time to stone passage was 7 d in the tamsulosin arm and 10 d in the placebo arm (log-rank test, p=0.36). Patients in the tamsulosin arm required significantly fewer analgesics than patients in the placebo arm (median: 3 vs 7, p=0.011). A caveat is that the exact time of stone passage was missing for 29 patients. Tamsulosin treatment does not improve the stone expulsion rate in patients with distal ureteral stones < or = 7 mm. Nevertheless, patients may benefit from a supportive analgesic effect. CLINICALTRIALS.GOV: NCT00831701.
    Full-text · Article · Apr 2009 · European Urology
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