Drug Therapies to Facilitate Passage of Ureteral Stones

 In a meta-analysis of 22 trials, -blockers and calcium-channel blockers increased the rate of spontaneous expulsion of moderate-sized distal stones.

A recent meta-analysis of 9 studies that included 700 patients supported the use of -blockers or calcium-channel blockers to facilitate passage of ureteral stones (Journal Watch Oct 26 2006). In a new and updated meta-analysis, investigators included 22 randomized trials involving nearly 2000 patients, most of whom had distal ureteral stones 5 mm in diameter.

Tamsulosin (Flomax) was the most commonly used -blocker. Time to stone passage was shortened by an average of 2 to 6 days in the -blocker groups compared with controls, and -blocker recipients were more likely than controls to pass stones without need for additional intervention (risk ratio, 1.59). Findings were similar in the calcium-channel blocker trials, all of which used nifedipine. Roughly four patients had to be treated to prevent one case of failure to pass a stone.

Comment: This meta-analysis, which covered a large number of small studies, found that tamsulosin and nifedipine facilitate the passage of moderate-sized distal ureteral stones. Although the authors rated the quality of the studies as poor overall (absence of blinding was the most common reason), the potential benefits of these generally well-tolerated drugs probably outweigh the potential harms for most patients.

— Allan S. Brett, MD

Published in Journal Watch General Medicine November 8, 2007

Citation(s):

Singh A et al. A systematic review of medical therapy to facilitate passage of ureteral calculi. Ann Emerg Med 2007 Nov; 50:552.