📃 Paper Title: Distal Ureteric Stones and Tamsulosin: A Double-Blind, Placebo-Controlled, Randomized, Multicenter Trial
🧍 Author: Furyk
🕒 Year: 2014
📚 Journal: Annals of Emergency Medicine
🌎 Country: Australia
ㅤContext to the study:
What is a paper that supports use of a-blockers for larger (>5mm) ureteric stones?
ㅤ✅ Take-home message of study:
In larger (>5mm) distal stones, a-blockers may potentially increase stone passage rates (however, in this study the number needed to treat was 4.5).
However, no benefit was seen in stones >10mm or <5mm
ㅤ RCT (double-blind, placebo-controlled)
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Study participants:
403 participants
Patients were allocated to 400 mcg tamsulosin or a placebo once daily for 28 days.
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Key study outcomes:
The primary outcomes were stone expulsion on CT at 28 days and time to stone expulsion.
Stone passage occurred in 140 of 161 (87.0%) in the tamsulosin group and 127 of 155 (81.9%) with placebo, a non statistically significant difference of 5.0% (95% CI -3.0% to 13.0%)
In a subgroup analysis of large stones (5 to 10 mm), 30 of 36 (83.3%) tamsulosin participants had stone passage compared with 25 of 41 (61.0%) with placebo, a statistically significant difference of 22.4% (95% confidence interval 3.1% to 41.6%)
Median time for spontaneous stone passage was 7 days (95% CI 5-10 days) in the tamsulosin group and 11 days (95% CI 6-14 days) in the placebo group, however this was not statistically significant.
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Study Limitations:
Compliance with tamsulosin was generally poor.
Potential selection bias
did not obtain a follow-up CT for approximately 17% of participants in both groups.
Anticipated approximately 4 small stones for every large stone, but the observed rate of small stones was less.
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