From the Guidelines
Flomax (Tamsulosin) is effective for facilitating the passage of ureteral stones, including in women with 4mm ureteral stones, as it has been shown to increase the likelihood of stone passage by 29% compared to control patients 1. When considering the treatment of ureterolithiasis in women, the primary goal is to alleviate symptoms and facilitate stone passage while minimizing morbidity and mortality.
- The use of alpha blockers, such as tamsulosin, has been demonstrated to be effective in facilitating ureteral stone passage, with a statistically significant benefit compared to control patients 1.
- The mechanism of action of tamsulosin, which involves relaxation of ureteral smooth muscle through alpha-1 receptor blockade, is thought to contribute to its beneficial effects in this setting 1.
- While the majority of studies on tamsulosin for ureteral stones have been conducted in men, the available evidence suggests that it may also be effective in women, although further studies are needed to confirm this 1.
- In terms of specific treatment recommendations, women with 4mm ureteral stones may be considered for medical expulsive therapy with tamsulosin, in addition to pain management and hydration, under the guidance of a healthcare provider.
- It is essential to note that the standard adult dose of Flomax is 0.4mg once daily, and patients should be monitored for potential side effects and complications, such as hypotension and urinary retention.
- Ultimately, the decision to use tamsulosin for ureteral stones in women should be made on a case-by-case basis, taking into account individual patient factors and the potential benefits and risks of treatment 1.
From the Research
Effectiveness of Flomax (Tamsulosin) for Women with 4mm Ureteral Stones
- The study 2 found that tamsulosin did not significantly increase the stone passage rate compared with placebo for symptomatic urinary stones smaller than 9 mm.
- A systematic review and meta-analysis 3 suggested that tamsulosin significantly improves stone passage in patients with larger stones (5 to 10 mm), but the effect of tamsulosin is diminished in those with smaller stones (<4 to 5 mm).
- Another systematic review 4 found that medical expulsive therapy using alpha-antagonists, such as tamsulosin, significantly improved spontaneous stone expulsion in patients with distal ureteral stones.
Specific Findings for 4mm Ureteral Stones
- The study 5 found that 96.1% of patients with a stone 0-4mm managed to expel their ureteral stone with conservative management.
- However, the study 2 did not find a significant benefit of tamsulosin for stones smaller than 9 mm, which would include 4mm stones.
- The meta-analysis 3 also found no benefit of tamsulosin for small stones (<4 to 5 mm).
Comparison with Other Treatments
- The study 6 found that silodosin, a selective α-1a receptor antagonist, was well tolerated and beneficial in facilitating the passage of distal ureteral stones, but did not demonstrate a benefit for the entire ureter.
- The systematic review 4 found that calcium channel blockers also improved spontaneous stone expulsion in patients with distal ureteral stones.