The Effect of Alpha-Blockade in Emergency Department Patients with Ureterolithiasis

• Published in: The Journal of emergency medicine 2010-04, Vol.38 (3), p.368-373
• Main Authors: Watts, Hannah F., MD, Tekwani, Karis L., MD, Chan, Cindy W., MD, Rzechula, Kathleen H., RN, Kulstad, Erik B., MS, MD
• Format: Article
• Language: English
• Subjects: Adrenergic alpha-Antagonists - therapeutic use; Adult; alpha-blockade; Cohort Studies; Emergency; Emergency Service, Hospital; Female; Humans; Interviews as Topic; Male; Middle Aged; Retrospective Studies; Sulfonamides - therapeutic use; tamsulosin; Tomography, X-Ray Computed; Treatment Outcome; ureterolithiasis; Ureterolithiasis - diagnostic imaging; Ureterolithiasis - drug therapy; urolithiasis
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2008.08.032

Abstract Background: Recent studies suggest that alpha-blockade with tamsulosin may be useful in the treatment of ureterolithiasis by increasing the success of, and decreasing the time to, stone passage. Objectives: We sought to determine stone passage success rates in patients diagnosed with ureterolithiasis and discharged from our Emergency Department (ED) with tamsulosin. Methods: We conducted a non-randomized retrospective cohort study over a 1-year period during which we made monthly follow-up telephone calls to patients discharged from our ED with a diagnosis of ureterolithiasis determined by computed tomography (CT) scan. Stone size and location (proximal, middle, or distal ureter) were determined from radiologist reports and prescriptions were determined from electronic medical records. Patients were asked if they spontaneously passed their stone, how much time was required before stone passage, and if any subsequent hospital visit was required after discharge due to pain or complication resulting from the ureteral stone. Results: During the study, a total of 213 patients were discharged from the ED with ureterolithiasis diagnosed by CT scan; of these, 119 (56%) were successfully contacted and 113 (53%) agreed to participate. Of the 113 patients, 83 (73%) had been prescribed tamsulosin and 30 (27%) had not. Overall age (43 years), gender (67% male), median stone size (3 mm, interquartile range 2–4 mm), and location (71% distal ureter) were similar in the two cohorts. Of tamsulosin recipients, 84% (95% confidence interval [CI] 75–91%) reported passing their stone, whereas 60% (95% CI 42–75%) of non-recipients passed their stone. Conclusion: Patients with ureterolithiasis discharged from our ED and given tamsulosin by prescription had moderately high ureteral stone passage success rates in our non-randomized retrospective cohort study. Compared to non-recipients of tamsulosin, patients receiving tamsulosin seemed to have greater success in stone passage.