Tamsulosin proven safe, effective for ureteral stones
Results of a recent meta-analysis show the efficacy and relative safety of tamsulosin in patients with ureteral stone as a medical expulsive therapy to facilitate stone passage.
Additionally, tamsulosin must be administered selectively in patients with 5–10 mm ureteral stones, according to the authors.
Fifty-six randomized controlled trials (RCTs), involving 9,395 patients, were included. In the observed treatment effect, tamsulosin correlated with a higher rate of stone expulsion (risk ratio [RR], 1.44; 95 percent CI, 1.35–1.55; p<0.01), a shorter stone expulsion time (weighted mean difference [WMD], –0.73; 1.00 to –0.45; p<0.01), and fewer incidences of of ureteral colic (WMD, –0.81; –1.24 to –0.39; p<0.01) and requiring subsequent intervention (RR, 0.68; 0.50–0.93; p=0.017).
The overall incidence of side effects (RR, 1.14; 0.86–1.51; p=0.36) did not differ between patients treated with tamsulosin and those in the control group. Subgroup analysis indicated a significant benefit in the stone expulsion rate for tamsulosin among patients with stones >5 mm (RR, 1.44; 1.22–1.68; p<0.01). However, there was no effect for stones ≤5 mm (RR, 1.08; 0.99–1.68; p<0.01).
A systematic search of Medline, Embase, Googhle Scholar, Web of Knowledge and Cochrane Central Search Library databases up to June 2018 was performed. Eligible RCTs of the efficacy of tamsulosin in treating ureteral stones were evaluated independently by two reviewers. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the quality of studies. Finally, heterogeneity was explored through subgroup analyses.
“Tamsulosin is widely administered as a medical expulsive therapy to facilitate stone passage in patients with ureteral calculi. Recently several large, multicenter, randomized controlled trials revealed conflicting results, which led to considerable uncertainty about the efficacy of tamsulosin in the management of ureteral stones,” the authors noted.