Effect of Tamsulosin on Stone Passage for Ureteral Stones: A Systematic Review and Meta-analysis.
OBJECTIVE
Tamsulosin is recommended for patients receiving a diagnosis of a ureteral stone less than 10 mm who do not require immediate urologic intervention. Because of conflicting results from recent meta-analyses and large randomized controlled trials, the efficacy of tamsulosin is unclear. We perform a systematic review and meta-analysis to investigate the effect of tamsulosin on stone passage in patients receiving a diagnosis of ureteral stone.


METHODS
MEDLINE, EMBASE, and CENTRAL databases were searched without language restriction through November 2015 for studies assessing the efficacy of tamsulosin and using a double-blind, randomized, controlled trial design. Meta-analysis was conducted with a random-effects model and subgroup analyses were conducted to determine sources of heterogeneity.


RESULTS
Eight randomized controlled trials (N=1,384) contained sufficient information for inclusion. The pooled risk of stone passage in the tamsulosin arm was 85% versus 66% in the placebo arm, but substantial heterogeneity existed across trials (I2=80.2%; P<.001). After stratifying of studies by stone size, the meta-analysis of the large stone subgroup (5 to 10 mm; N=514) indicated a benefit of tamsulosin (risk difference=22%; 95% confidence interval 12% to 33%; number needed to treat=5). The meta-analysis of the small stone subgroup (<4 to 5 mm; N=533) indicated no benefit (risk difference=-0.3%; 95% confidence interval -4% to 3%). Neither meta-analysis for the occurrence of dizziness or hypotension showed a significant effect.


CONCLUSIONS
Tamsulosin significantly improves stone passage in patients with larger stones, whereas the effect of tamsulosin is diminished in those with smaller stones, who are likely to pass their stone regardless of treatment.
Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA. Electronic address: ralph.wang@ucsf.edu.
Ralph C
RC
Wang
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.
Rebecca
R
Smith-Bindman
UCSF Medical Library, University of California, San Francisco, San Francisco, CA.
Evans
E
Whitaker
Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA.
Jersey
J
Neilson
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.
Isabel Elaine
IE
Allen
Department of Urology, University of California, San Francisco, San Francisco, CA.
Marshall L
ML
Stoller
Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA.
Jahan
J
Fahimi
D006801:Humans; D013449:Sulfonamides / Q000627:therapeutic use*; D000077409:Tamsulosin; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000188:drug therapy*; D064804:Urological Agents / Q000627:therapeutic use*
D013449:Sulfonamides; D064804:Urological Agents; D000077409:Tamsulosin