Author information Copyright and License information Disclaimer S. Abstract Renal stone disease often begins by renal colic. In order to manage this event adequately, several goals should be pursued: first, attenuate pain; second, favour progression and spontaneous expulsion of stones; third, prevent from obstructive and infectious complications. All of the aforementioned points pertain to medical management of this disease. Concerning prevention, it is widely agreed that pathogenesis of kidney stones is a consequence of abnormalities in urine environment, leading to a disequilibrium between promoters and inhibitors of crystallization. Therefore, the rationale for therapy is to make urine less conductive to stone formation, by both decreasing state of saturation and increasing inhibitory potential.
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Find out which of your patients can benefit. Effect of tamsulosin on stone passage for ureteral stones: a systematic review and meta-analysis. Ann Emerg Med. He is deemed appropriate for outpatient management. In addition to pain medications, should you prescribe tamsulosin? According to the most recent National Health and Nutrition Examination Survey, the population prevalence of kidney stones is 8. In fact, the European Association of Urology guideline on urolithiasis states that MET may accelerate passage of ureteral stones.
Two systematic reviews, limited by heterogeneity because some of the studies lacked a placebo control and blinding, concluded that alpha-blockers increased stone passage within one to 6 weeks when compared with placebo or no additional therapy.
Although the initial search included studies published between and , the 8 that were eventually analyzed were published between and , were conducted in multiple countries and included regardless of language , and were conducted in ED and outpatient urology settings. The main outcome measure was the risk difference in stone passage between the tamsulosin group and placebo group after follow-up imaging at 3 weeks with CT or plain film radiographs.
Tamsulosin helps some, but not all. Prior meta-analyses did not. J Fam Pract. The different results based on stone size may explain the recent uncertainty as to whether tamsulosin improves the rate of stone passage. Thus, this meta-analysis was unable to determine the effect on more proximal stones.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health. References 1. Prevalence of kidney stones in the United States. Eur Urol. EAU guidelines on diagnosis and conservative management of urolithiasis.
Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis. Alpha-blockers as medical expulsive therapy for ureteral stones.
Cochrane Database Syst Rev. Medical expulsion therapy in adults with ureteric colic: a multicentre, randomized, placebo-controlled trial. Kidney stones?
Nephrolithiasis: Diagnosis and Management in the ED
Find out which of your patients can benefit. Effect of tamsulosin on stone passage for ureteral stones: a systematic review and meta-analysis. Ann Emerg Med. He is deemed appropriate for outpatient management. In addition to pain medications, should you prescribe tamsulosin? According to the most recent National Health and Nutrition Examination Survey, the population prevalence of kidney stones is 8.
Treatment and Prevention of Kidney Stones: An Update
References The incidence of nephrolithiasis kidney stones is rising worldwide, especially in women and with increasing age. Kidney stones are associated with chronic kidney disease. Preventing recurrence is largely specific to the type of stone e. Medications, such as protease inhibitors, antibiotics, and some diuretics, increase the risk of some types of kidney stones, and patients should be counseled about the risks of using these medications. Managing diet, medication use, and nutrient intake can help prevent the formation of kidney stones. Obesity increases the risk of kidney stones. However, weight loss could undermine prevention of kidney stones if associated with a high animal protein intake, laxative abuse, rapid loss of lean tissue, or poor hydration.
Alpha Blockers for Nephrolithiasis
How effectively do alpha blockers increase ureteral stone passage? Evidence-Based Answer The alpha blocker tamsulosin Flomax can be used to improve clearance of stones larger than 5 mm, shorten expulsion times, and reduce hospitalization. Strength of Recommendation: B, based on meta-analyses of moderate-quality randomized controlled trials. Alfuzosin Uroxatral , doxazosin Cardura , and silodosin Rapaflo are also effective but have significantly more adverse effects. Summary A Cochrane review compared alpha blockers with placebo or standard therapy for urinary stone expulsion.