Tamsulosin for the treatment of Distal Ureteric Calculi: A Double Blinded, Placebo-Controlled, Randomized, Multi-Centre trial

Will administering the drug Tamsulosin improve the rates of spontaneously passing stones less than 10mm in diameter, as well as reduce patient pain or their need for surgery and complications?

Grant ID: PROJ-2009-013-FURYK-TARDUS

Project Summary

Ureteric colic (or Kidney stones) is a significant public health concern within Australia, affecting as many as 5-15% of adults. As a result, a significant number of Australians experience significant pain, hospital and outpatient visits, and the potential for more significant complications such as infection, kidney damage and the need for surgical treatments.

Although several methods of medical treatments to improve care of such patients have been studied overseas, some of which appear promising, the practice of “medical expulsive therapy” for ureteric colic is not widely practiced in Australia. One such medication is Tamsulosin, which seems to have an effect on the ureter (tube from kidney to bladder) and helps stones pass. It is already in use for other urological conditions already in Australia, and studies overseas seem to show benefit for patients with Ureteric colic.

Within Queensland Health there is substantial variation with regard to access to specialist urologist services. Benefits of medical therapies for ureteric colic may be even greater in geographically isolated areas without full time urology services.

Patients who present to the participating emergency departments with Ureteric calculi, that fit the inclusion criteria will be randomly allocated to either the study medication (Tamsulosin 0.4mg daily) or placebo. The patients will then be closely monitored for four weeks, to determine if the stones pass spontaneously, or if any complications occur. At four weeks the study will be complete, patients who are yet to have passed the stone, would be referred to Urology for consideration of a procedure.

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Outcomes

The trial included 403 patients. The research team found tamsulosin increased the passage of large stones (5-10mm), but there was no benefit overall of 0.4 mg of tamsulosin daily for patients with smaller stones in terms of spontaneous passage, time to stone passage, pain, or analgesia requirements.

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Dissemination

Furyk, J.S., Chu, K., Banks, C., Greenslade, J., Keijzers, G., Thom, O., Torpie, T., Dux, C. and Narula, R., 2016. Distal ureteric stones and tamsulosin: a double-blind, placebo-controlled, randomized, multicenter trial. Annals of emergency medicine, 67(1), pp.86-95.

Furyk, J.S., Velusamy, K., Banks, C. and Jones, L., 2015. 319 Systematic Review: Tamsulosin in the Management of Distal Ureteric Colic. Annals of Emergency Medicine, 66(4), pp.S115-S116.

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