From the Guidelines
Tamsulosin can be prescribed for renal stones, specifically to facilitate the passage of ureteral stones, as it has been shown to be effective in increasing the likelihood of stone passage and reducing stone-passage time and pain. According to the 2007 guideline for the management of ureteral calculi 1, alpha blockers, such as tamsulosin, are the preferred agents for medical expulsive therapy (MET) due to their ability to relax the smooth muscles in the ureter. The guideline cites a meta-analysis that found a statistically significant 29% increase in stone passage with alpha blocker therapy compared to control patients 1.
The standard dose of tamsulosin for this purpose is typically 0.4 mg taken orally once daily, and it is usually continued until the stone passes or for about 2-4 weeks if no passage occurs. It is essential for patients to take tamsulosin with food and at the same time each day to minimize side effects, which can include dizziness, retrograde ejaculation in men, and orthostatic hypotension. Adequate hydration is also crucial, with patients advised to drink at least 2-3 liters of water daily to help flush the stone. If severe pain, fever, or vomiting develops, medical attention should be sought immediately as these may indicate complications.
Key benefits of using tamsulosin for renal stones include:
- Increased likelihood of stone passage
- Reduced stone-passage time
- Decreased pain during the process
- Effective for stones located in the lower ureter It is worth noting that while tamsulosin has been the most common alpha blocker used in studies, other alpha blockers like terazosin and doxazosin may also be effective, as suggested by a small study mentioned in the guideline 1. However, tamsulosin remains the most studied and recommended option for MET in the context of ureteral stones.
From the Research
Tamsulosin for Renal Stones
- Tamsulosin can be prescribed for renal stones, specifically for distal ureteral stones, as it has been shown to facilitate stone passage and relieve renal colic 2, 3, 4, 5, 6.
- The efficacy of tamsulosin in treating ureteral stones is supported by several studies, including a systematic review and meta-analysis that found a 19% improvement in stone clearance with tamsulosin 4.
- Tamsulosin has been found to be effective in patients with stones greater than 5 mm, with a higher stone expulsion rate and shorter expulsion time compared to placebo 3, 5, 6.
- The use of tamsulosin has also been associated with a lesser incidence of ureteral colic and fewer incidences of requiring subsequent intervention 5.
- However, the effect of tamsulosin is diminished in patients with smaller stones (<5 mm), who are likely to pass their stone regardless of treatment 3, 5, 6.
Benefits of Tamsulosin
- Higher stone expulsion rate compared to placebo 2, 3, 4, 5, 6
- Shorter stone expulsion time compared to placebo 2, 3, 5, 6
- Lesser incidence of ureteral colic compared to placebo 5
- Fewer incidences of requiring subsequent intervention compared to placebo 5
- Relief of renal colic 6