For Passing Smaller Ureteral Stones, Tamsulosin May Be No Better Than Placebo

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

Tamsulosin is not associated with higher passage rates of ureteral stones smaller than 9 mm, according to a JAMA Internal Medicine study.

Roughly 500 adults presenting to the emergency department with symptomatic ureteral stones measuring less than 9 mm were randomized to receive either 0.4 mg tamsulosin or placebo daily for 28 days.

At the end of treatment, nearly half of patients had passed their stones, and the pass rates were similar between the groups. The tamsulosin group had higher rates of ejaculation dysfunction (18% vs. 7% for placebo).

Commentators write: "We agree with [the study authors] that guideline recommendations on medical expulsive therapy should be revisited. However, to say tamsulosin has no benefit for ureteral stones up to 9 mm in size may be an overreach, given that nearly three-quarters of patients in their study had ureteral calculi 4 mm or smaller in size."