Tamsulosin may be effective as medical expulsive therapy for patients who have residual kidney stone fragments after shockwave lithotripsy (SWL), according to the results of a randomized controlled trial presented at the European Association of Urology 2022 annual meeting in Amsterdam, The Netherlands.
In addition to facilitating fragment clearance, the medication shortens the time to stone-free status and decreases pain.
Abdelwahab Hashem, MD, of Mansoura Urology and Nephrology Center in Mansoura, Egypt, and colleagues randomly assigned 235 patients to receive tamsulosin 0.4 mg once daily or placebo from the first SWL session and for 3 months afterwards or until becoming stone free.
The investigators included 216 patients in their analysis: 107 in the tamsulosin arm and 109 in the placebo arm. The primary outcome was the 3-month stone-free rate (SFR) defined by the presence of 3 mm or smaller residual kidney stone fragments. They assessed stone-free rate using computed tomography.
The primary outcome was achieved by a significantly higher proportion of tamsulosin-treated patients compared with placebo recipients (73.8% vs 59.6%), Dr Hashem reported. Also at 3 months, 43% of the tamsulosin-treated patients had no evidence of any residual fragments compared with 15% of placebo recipients, a significant difference between the groups.
The tamsulosin group had a significantly lower median score on the Numeric Pain Rating Scale compared with the placebo group (3 vs 5).
At baseline, both study arms had similar characteristics. Patients in both groups had a median age of 51 years. The tamsulosin and placebo groups did not differ significantly with respect to body mass index (median 28 and 27 kg/m2, respectively), stone length (median 9 mm for both groups), stone width (7 and 6 mm, respectively), and skin-to-stone distance (10.5 and 10.1 cm, respectively).
Hashem A, Laymon M, Elgamal M, et al. Tamsulosin as medical expulsive therapy after shock wave lithotripsy for renal stones: A randomised controlled trial (NCT05032287). Presented at EAU22; July 1-4, 2022; Amsterdam, The Netherlands. Abstract A0264.