Medical expulsive therapy ineffective for ureteral stones
Medical expulsive therapy is ineffective in the treatment of ureteral stones, according to a large-scale study that was recently published.
“Medical expulsive therapy, particularly the alpha-blocker drug tamsulosin (Flomax), is increasingly prescribed for people with ureteric colic on the basis of summarized evidence from several small clinical trials that suggests it increases the chance of spontaneously passing the stone and not needing intervention to remove the stone,” lead study author Robert Pickard, MD, of the Institute of Cellular Medicine, Newcastle University, United Kingdom, told Urology Times.
“Our large, well powered, placebo-controlled, multicenter study carried [out] in a routine care setting with full masking of patients and clinicians to the treatment received has now found no evidence that medical expulsive therapy with tamsulosin or nifedipine is effective for these patients. Our judgment based on the trial result is that these drugs should no longer be recommended or used for the purpose of reducing the risk of needing intervention to remove stones for people with ureteric colic.”
For the study, which was published online in The Lancet (May 18, 2015), Dr. Pickard and colleagues enrolled 1,136 adults undergoing expectant management for a single ureteral stone, which included patients with symptomatic stones of 10 mm or smaller (at the largest dimension) located at any site in the ureter, according to the study. Participants were randomized to receive once-daily tamsulosin, 0.4 mg; nifedipine, 30 mg; or placebo for up to 4 weeks.
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