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Effect of tamsulosin on passage of symptomatic ureteral stones: A randomized clinical trial

Meltzer, AC; Burrows, PK; Wolfson, AB; Hollander, JE; Kurz, M; Kirkali, Z; Kusek, JW; ... Brown, J; + view all (2018) Effect of tamsulosin on passage of symptomatic ureteral stones: A randomized clinical trial. JAMA Internal Medicine , 178 (8) pp. 1051-1057. 10.1001/jamainternmed.2018.2259.

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Abstract

Importance: Urinary stone disease is a common presentation in the emergency department, and α-adrenergic receptor blockers, such as tamsulosin, are commonly used to facilitate stone passage. // Objective: To determine if tamsulosin promotes the passage of urinary stones within 28 days among emergency department patients. // Design, Setting, and Participants: We conducted a double-blind, placebo-controlled clinical trial from 2008 to 2009 (first phase) and then from 2012 to 2016 (second phase). Participants were followed for 90 days. The first phase was conducted at a single US emergency department; the second phase was conducted at 6 US emergency departments. Adult patients were eligible to participate if they presented with a symptomatic urinary stone in the ureter less than 9 mm in diameter, as demonstrated on computed tomography. // Interventions: Participants were randomized to treatment with either tamsulosin, 0.4 mg, or matching placebo daily for 28 days. // Main Outcomes and Measures: The primary outcome was stone passage based on visualization or capture by the study participant by day 28. Secondary outcomes included crossover to open-label tamsulosin, time to stone passage, return to work, use of analgesic medication, hospitalization, surgical intervention, and repeated emergency department visit for urinary stones. // Results: The mean age of 512 participants randomized to tamsulosin or placebo was 40.6 years (range, 18-74 years), 139 (27.1%) were female, and 110 (22.8%) were nonwhite. The mean (SD) diameter of the urinary stones was 3.8 (1.4) mm. Four hundred ninety-seven patients were evaluated for the primary outcome. Stone passage rates were 50% in the tamsulosin group and 47% in the placebo group (relative risk, 1.05; 95.8% CI, 0.87-1.27; P = .60), a nonsignificant difference. None of the secondary outcomes were significantly different. All analyses were performed according to the intention-to-treat principle, although patients lost to follow-up before stone passage were excluded from the analysis of final outcome. // Conclusions and Relevance: Tamsulosin did not significantly increase the stone passage rate compared with placebo. Our findings do not support the use of tamsulosin for symptomatic urinary stones smaller than 9 mm. Guidelines for medical expulsive therapy for urinary stones may need to be revised. // Trial Registration: ClinicalTrials.gov Identifier: NCT00382265

Type: Article
Title: Effect of tamsulosin on passage of symptomatic ureteral stones: A randomized clinical trial
DOI: 10.1001/jamainternmed.2018.2259
Publisher version: http://dx.doi.org/10.1001/jamainternmed.2018.2259
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
URI: https://discovery.ucl.ac.uk/id/eprint/10055345
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