Coronavirus News Center. A year-old man presents to the emergency department ED with acute-onset left flank pain that radiates to the groin. He is deemed an appropriate candidate for outpatient management. In addition to pain medications, should you prescribe tamsulosin?
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Compared with patients receiving standard therapy e. Adverse effects of alpha blocker therapy are generally tolerable. Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence. The authors of this Cochrane meta-analysis evaluated the role of alpha blockers as a medical therapy to speed the passage of ureteral stones. Participants were symptomatic adults with radiologically confirmed ureteral stones 10 mm or smaller.
Exclusion criteria included urinary tract infection, hydronephrosis, or other underlying abnormalities of the kidney or ureters.
Alpha blockers used included tamsulosin Flomax; 0. The majority of studies ran two to four weeks and compared alpha-blocker therapy plus standard therapy hydration, pain killers, nonsteroidal anti-inflammatory drugs, corticosteroids, prophylactic antibiotics with standard therapy plus placebo. Others compared alpha blockers with calcium channel blockers such as nifedipine Procardia; 30 mg or the antimuscarinic tolterodine Detrol; 4 mg.
The overall stone expulsion time was three days shorter with alpha blockers than with standard therapy, with a mean expulsion time of seven rather than 10 days. A Chinese RCT of 3, patients accounted for most of the latter findings; the study was appropriately masked and considered at low risk of bias.
The benefits of alpha blockers were robust, irrespective of whether the stone was smaller than 5 mm or was 5 to 10 mm in diameter. Only five studies reported adverse effects. Most adverse effects were mild and did not lead to cessation of therapy. Specialty guidelines published in recommend use of alpha blockers to help pass subcentimeter ureteral stones in otherwise stable patients. Family physicians should consider alpha blockers as first-line therapy for patients with otherwise uncomplicated subcentimeter ureteral stones.
Already a member or subscriber? Log in. Alphablockers as medical expulsive therapy for ureteral stones. Cochrane Database Syst Rev. Epidemiology of nephrolithiasis. J Nephrol. A multicentre, prospective, randomized trial: comparative efficacy of tamsulosin and nifedipine in medical expulsive therapy for distal ureteric stones with renal colic. BJU Int.
J Urol. This series is coordinated by Corey D. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv aafp.
Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Next: Buprenorphine Maintenance vs. Feb 1, Issue. Author disclosure: No relevant financial affiliations. Clinical Question Do alpha blockers safely speed passage of subcentimeter ureteral stones? Evidence-Based Answer Compared with patients receiving standard therapy e.
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Tamsulosin for kidney stones: The STONE trial
Data Sources: PubMed search performed November 15, , using the following search terms: alpha-blocker, alfuzosin, silodosin, or tamsulosin AND kidney or ureteral stones. Additional studies found through references of primary and tertiary literature. Inclusion criteria included English language, randomized controlled trials not included in meta-analyses , and meta-analyses evaluating US available alpha-blockers as medical expulsive therapy with or without lithotripsy in adults with renal or ureteral stones, and no date limits. Study Selection and Data Extraction: Seven randomized controlled trials RCTs , 1 case-control trial, and 6 meta-analyses were found and included in this review.
The Use of Alpha-Blockers for the Treatment of Nephrolithiasis
Background: Ureteric renal colic is a common, painful condition encountered in the Emergency Department ED. Sustained contraction of smooth muscle in the ureter as a kidney stone passes the length of the ureter leads to pain. The majority of stones will pass spontaneously i. For over a decade, calcium channel blockers i. These interventions were mostly based on poor methodologic studies and meta-analyses of these flawed studies Hollingsworth