Tamsulosin Facilitates Passage of Ureteral Stones 4–10 mm in Size

Prior research has suggested absence of benefit from tamsulosin, an alpha-1A antagonist, for facilitating passage of ureteral stones <10 mm in size (NEJM JW Gen Med Jul 1 2015 and Lancet 2015; 386:341). Now, investigators conducted a systematic review and meta-analysis of randomized controlled trials of tamsulosin, stratifying the results by stone size (<4 mm vs. 4–10 mm).

Eight randomized trials including 1384 participants with stones <10 mm in size met criteria for the meta-analysis. Patients received tamsulosin (0.4 mg daily) or placebo for 21, 28, or 42 days. In pooled analysis, stone passage without urological intervention occurred in 85% of tamsulosin patients versus 66% of placebo patients, for a significant risk difference of 17%. Dizziness and orthostatic hypotension did not occur more frequently in the tamsulosin group. In a preplanned subgroup analysis, the authors found no benefit from tamsulosin for stone passage in patients with stones <4 mm in size (risk difference, 0%), but a substantial benefit for those with stones 4–10 mm in size (risk difference, 22%; number needed to treat, 5).