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Tamsulosin for Treatment of ED Patients with Renal Colic?
Tamsulosin provided no benefit over conventional outpatient analgesic therapy in adult ED patients with small, distal renal ureteral stones.
Tamsulosin, an 
-adrenergic antagonist commonly used in the treatment of prostatic hypertrophy, has become a common treatment in the emergency department for renal colic caused by distal ureterolithiasis, based entirely on a small body of evidence that supports its use in the outpatient urology setting. In a prospective trial, 71 adult patients who presented to a single ED in Maine with renal colic caused by distal ureterolithiasis that was diagnosed by computed tomography (mean stone size, 3.6 mm) were randomized to receive 10 days of conventional outpatient therapy with ibuprofen and oxycodone alone or with tamsulosin (0.4 mg/day).
Spontaneous passage of ureteral stones at 14 days (the primary outcome) did not differ significantly between the tamsulosin and conventional-therapy groups (77% and 65% of patients, respectively). In addition, no significant differences were noted between groups in time to stone passage, self-reported pain scores, number of colicky pain episodes, unscheduled return ED or primary care visits, number of missed workdays, amount of analgesic used, or incidence of adverse events.
Comment: This is not the first time that a therapy that had been shown to be effective for a subspecialty outpatient population fails to show similar results for ED patients with apparently comparable disease. Routine use of tamsulosin for ED patients with renal colic caused by small (
4 mm) distal stones likely has no value. More study is required to determine its usefulness in ED patients with larger or more-proximal stones.
Published in Journal Watch Emergency Medicine October 9, 2009
Citation(s):
Ferre RM et al. Tamsulosin for ureteral stones in the emergency department: A randomized, controlled trial. Ann Emerg Med 2009 Sep; 54:432.
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- wrong conclusion
Stephen W. Smith, Hennepin County Medical Center, 4 Jan 2010 1:06 PM EST
Spontaneous passage DID indeed differ: 12% more had passage in the tamsulosin group. This is a problem with the power... [more]
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