AUA 2017: Randomized Clinical Trial of Treatment With Tamsulosin Begun In The Emergency Department To Promote Passage Of Urinary Stones

Boston, MA ( Urinary stone disease is very common affecting 1 in 11 people over a life time with a prevalence that doubled past 15 years. Patient visits to the ED have increased over the past few years. Alpha blockers have been used for stone expulsion. A multi-center, double-blind, placebo-controlled clinical trial was conducted using the tamsulosin, alpha-blocker, in the ED to treat ureteral stones less than 9 mm in diameter. This study was used to determine if tamsulosin improves the expulsion rate of these ureteral stones compared to a placebo.

Patients were recruited in the ED for this study and given either tamsulosin (0.4mg) once a day for 28 days or a placebo for the same amount of days. Patients were ≥18 years of age and had to present with symptoms that were consistent with renal colic. Their stone dimension had to be < 9mm. Patients included did not have any prior GY surgery, no urine infection, and had evidence of ureterolithiasis on CT at the time of ED presentation. The primary outcome was to see whether their was stone expulsion and this would be recorded by the patient within 28 days. A phone follow up was conducted to collect data. A Chi-Square test was used to compare the results for both groups post 28 days. Secondary outcomes were used to confirm stone passage in patients using a follow up CT.

512 patients were randomized. After the 28 day mark, 52% of patients in the tamsulson group and 49% of patients in the placebo group had passed a stone. The results were not statistically significant. Using tamsulson as treatment did not improve the rate of stone expulsion compared to placebo patients. In conclusion, these findings are consistent with two large clinical trials, Pickard, 2015 and Furyk, 2016, showing no benefit of using tamsulosin to pass ureteral stones.

Presented By: Andrew C. Meltzer

Author(s): Andrew C. Meltzer, Judd E. Hollander, Allan B. Wolfson, Michael C. Kurz, Stephen V. Jackman, Ziya Kirkali, John W. Kusek, Pamela K. Burrows

Affiliation: Washington, DC, Philadelphia, PA, Pittsburgh, PA, Birmingham, AL, Pittsburgh, PA, Bethesda, MD, Rockville, MD

Written By: Kheira Bettir, University of Irvine, California for

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA