Is Flomax (tamsulosin) still used in the treatment of renal calculi?

From the Guidelines

Flomax (tamsulosin) is still used in the treatment of renal calculi, particularly for facilitating the spontaneous passage of ureteral stones. The use of alpha blockers like tamsulosin has been supported by studies, such as the 2007 guideline for the management of ureteral calculi 1, which demonstrated that alpha blocker therapy resulted in a statistically significant 29% more patients passing their stones compared to control patients. Key points to consider in the use of tamsulosin for renal calculi treatment include:

• The standard dose is typically 0.4 mg taken orally once daily, usually after the same meal each day.
• Treatment generally continues until the stone passes or for about 2-4 weeks if passage doesn't occur.
• Tamsulosin works as an alpha-1 adrenergic receptor blocker that relaxes smooth muscle in the ureter, which helps facilitate stone passage by reducing spasm and increasing urinary flow.
• This medication is most effective for stones located in the distal ureter and those smaller than 10 mm in diameter.
• Patients should be aware of potential side effects including dizziness, headache, retrograde ejaculation in men, and orthostatic hypotension, particularly with the first dose. It's essential to use tamsulosin as part of a comprehensive approach that may include pain management and follow-up imaging to monitor stone position, as recommended by the guideline 1.

From the Research

Use of Flomax in Renal Calculi Treatment

• Flomax, also known as tamsulosin, is still used in the treatment of renal calculi, with studies showing its effectiveness in facilitating stone passage and reducing expulsion time 2, 3, 4, 5, 6.
• The medication is an alpha-blocker that helps to relax the muscles in the ureter, allowing for easier stone passage 2.
• Research has shown that tamsulosin is associated with a higher stone expulsion rate and shorter expulsion time compared to conservative management alone 2, 3.
• A systematic review and meta-analysis of randomized controlled trials found that tamsulosin was effective in facilitating stone passage, with a higher stone expulsion rate and shorter expulsion time compared to controls 3.
• Another study found that tamsulosin improved stone clearance rates after extracorporeal shock wave lithotripsy (ESWL) for renal and ureteral calculi 4, 5.

Efficacy of Tamsulosin in Renal Calculi Treatment

• The efficacy of tamsulosin in renal calculi treatment has been demonstrated in several studies, with stone expulsion rates ranging from 60-80% 2, 3.
• A meta-analysis of 29 trials found that tamsulosin was associated with a 19% improvement in stone clearance compared to standard therapy 6.
• Tamsulosin has also been shown to reduce the need for subsequent interventions, such as ureteroscopy or ESWL 3.
• The medication is generally well-tolerated, with few adverse effects reported 2, 3, 5, 6.

Recommendations for Use

• Tamsulosin is recommended for patients with distal ureteral stones, particularly those with stones larger than 5 mm 3.
• The medication may also be beneficial for patients with proximal ureteral stones, although the evidence is less clear 2.
• Tamsulosin should be used selectively, taking into account the size and location of the stone, as well as the patient's overall health status 3, 6.