Results from a few studies have suggested that certain
medications can hasten passage of distal ureteral calculi. In this
Italian trial, 210 patients with symptomatic distal ureteral calculi
larger than 4 mm (mean, 6.5 mm) were randomized to receive up to
28 days of the
-blocker tamsulosin
(Flomax; 0.4 mg daily), the calcium-channel blocker nifedipine (30 mg
daily), or the anticholinergic agent phloroglucinol. All three drugs
are presumed to reduce ureteral smooth muscle spasm. All patients
also received oral corticosteroids (to reduce ureteral edema at the
site of the stone) and the nonsteroidal anti-inflammatory drug
diclofenac.
Spontaneous passage of the stone occurred in significantly more tamsulosin recipients than nifedipine or phloroglucinol recipients (97% vs. 77% and 64%). Median time to stone passage was 3 days in the tamsulosin group and 5 days in the other two groups — a significant difference.
Although these findings suggest impressive results with tamsulosin, the trial suffers from several limitations, including lack of blinding and lack of a control group that was treated with analgesics alone. Moreover, the report doesn't indicate whether stone passage was documented by retrieval of the stone. However, if the findings can be duplicated in a methodologically strong study, we might have a way to reduce the duration of symptoms and to reduce the requirement for lithotripsy or ureteroscopy.
Reference:
Dellabella M et al. Randomized trial of the efficacy of tamsulosin, nifedipine and phloroglucinol in medical expulsive therapy for distal ureteral calculi. J Urol 2005 Jul; 174:167-72.