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Effect of Tamsulosin on Passage of Symptomatic Ureteral Stones: A Randomized Clinical Trial.

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.

journal_name

JAMA Intern Med

journal_title

JAMA internal medicine

authors

Meltzer AC,Burrows PK,Wolfson AB,Hollander JE,Kurz M,Kirkali Z,Kusek JW,Mufarrij P,Jackman SV,Brown J

doi

10.1001/jamainternmed.2018.2259

subject

Has Abstract

pub_date

2018-08-01 00:00:00

pages

1051-1057

issue

eissn

2168-6106

issn

2168-6114

pii

2684477

journal_volume

178

pub_type

杂志文章,随机对照试验

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Effect of Tamsulosin on Passage of Symptomatic Ureteral Stones: A Randomized Clinical Trial.