From the Guidelines
Tamsulosin is an effective treatment for facilitating the passage of kidney stones, particularly those in the ureter, with a statistically significant 29% increase in stone passage compared to control patients. The use of tamsulosin, an alpha blocker, has been shown to relax the smooth muscles in the ureter, allowing for easier stone passage and reduced pain 1.
Key Points to Consider
- Tamsulosin has been found to be more effective than nifedipine, a calcium channel blocker, in facilitating stone passage 1.
- The beneficial effects of tamsulosin are likely due to its ability to inhibit alpha-1 receptor blockade, leading to ureteral smooth muscle relaxation 1.
- While tamsulosin is the most commonly used alpha blocker for this purpose, other alpha blockers such as terazosin and doxazosin may also be effective 1.
- It is essential to note that tamsulosin is not effective for preventing stone formation and works best when combined with appropriate pain management.
Recommendations for Use
- The typical dose of tamsulosin for facilitating stone passage is 0.4 mg taken once daily 1.
- Patients should be advised to stay well-hydrated by drinking plenty of water to help flush out the stone.
- Tamsulosin is most effective for stones between 5-10 mm in size and located in the lower ureter 1.
- Patients should be monitored for potential side effects, including dizziness, headache, abnormal ejaculation, and nasal congestion.
- If patients experience severe pain, fever, or inability to urinate while passing a stone, they should seek immediate medical attention regardless of tamsulosin use.
From the Research
Effectiveness of Tamsulosin for Kidney Stones
- Tamsulosin has been shown to be effective in promoting the passage of distal ureteral stones, particularly those with a diameter of less than 8 mm 2.
- A systematic review and meta-analysis found that tamsulosin significantly improved stone passage in patients with larger stones (5-10 mm), but had no benefit for smaller stones (<4-5 mm) 3.
- Tamsulosin has also been found to reduce the need for analgesics and improve stone-free rates when used in combination with extracorporeal shock wave lithotripsy (ESWL) for renal stones 4, 5.
Stone Size and Tamsulosin Efficacy
- Studies have shown that tamsulosin is more effective for stones with a diameter of less than 10 mm 3, 5.
- For stones larger than 8 mm, ESWL may be more effective than tamsulosin 2.
- Tamsulosin has been found to be effective for renal stones 10-24 mm in diameter when used in combination with ESWL 4.