📃 Paper Title: Efficacy and Safety of Tamsulosin in Medical Expulsive Therapy for Distal Ureteral Stones with Renal Colic: A Multicenter, Randomized, Double-blind, Placebo-controlled Trial
🧍 Author: Ye
🕒 Year: 2017
📚 Journal: European Urology
🌎 Country: China
ㅤContext to the study:
Can you give a paper which supports use of a-blockers for distal ureteric stones?
ㅤ✅ Take-home message of study:
This very large RCT showed benefit of tamsulosin in a select population of distal ureteric stones.
Selective use in larger stones (e.g. 5mm) is more justified based on this study and is concurrent with some other randomised studies.
Though no difference in side effects were reported, this does not fit with other studies were placebo groups had lower rates of side effects.
ㅤ A Multicenter, Randomized, Double-blind, Placebo-controlled Trial
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Study participants:
3450 patients over a 2 year period
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Key study outcomes:
Higher stone expulsion rate seen with tamsulosin over placebo (86% vs 79%; p < 0.001) for distal ureteral stones.
Subgroup analysis identified a specific benefit of tamsulosin for the treatment of large distal ureteral stones (>5 mm).
Tamsulosin associated with:
shorter time to expulsion (p < 0.001)
lower use of analgesics compared with placebo (p < 0.001)
relieved renal colic (p < 0.001).
No differences in the incidence of adverse events were identified between the two groups
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Study Limitations:
No quality of life assessment
High rates of side effects reported in placebo (e.g. 4.6% of patients with placebo got retrograde ejaculation)
All patients with severe hydronephrosis were excluded (open to selection bias)
Different healthcare system and population (Asian)
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