Drugs help pass Renal Stone

From: www.jfponline.com

Drugs help pass
more ureteral stones
Evidence supports use of tamsulosin, nifedipine

Antagonist studies
These 16 studies enrolled 1235 patients with distal ureteral stones. Mean stone size ranged from 4.3 to 7.8 mm. α-Antagonists improved the stone expulsion rate (RR= 1.59, 95% CI 1.44-1.75; NNT=3.3).

The mean time to expulsion of the stone ranged from 2.7 to 14.2 days and duration of therapy ranged from 1 to 7 weeks. In the 9 trials that reported the time to stone expulsion, the stone came out between 2 and 6 days earlier than the control groups.

Adverse effects were reported in 4% of patients receiving the active medication; most were mild.

FAST TRACK
The stone passed 2 to 6 days earlier with tamsulosin


Nifedipine studies
There were 686 patients in the 9 trials of nifedipine. The mean stone size was 3.9 to 12.8 mm. Some studies included stones in the more proximal as well as the distal ureter.

Nifedipine treatment increased the rate of stone expulsion (RR=1.5, 95% CI 1.34-1.68; NNT=3.9). Time to stone expulsion was shorter in 7 of the 9 studies.

Adverse effects were reported in 15% of the patients. Most of these were mild— nausea, vomiting, asthenia, and dyspepsia.


WHAT’S NEW: Strong evidence for use of medical therapy

The new findings from the Singh meta-analysis reviewed in this PURL supports physicians who have already adopted this practice and should encourage usage by those who have not yet done so.