#EMConf: Flomax and Ureteral Stone Expulsion Rates

The Bottom Line: Tamsulosin for 28 days does not appear to have a statistically significant impact on facilitating stone expulsion in patients with ureteric stones when compared to placebo

Study 1: Meltzer 2018

  • Double-blind, randomized placebo-controlled trial of adults with symptomatic nephrolithiasis in the emergency department
  • 267 patients were randomized to receive tamsulosin 0.4mg once daily post ED discharge for 28 days, and 245 patients were randomized to receive placebo for the same time frame
  •  After 28 days, the urinary stone passage rate of 49.6% in the tamsulosin group did not have a significant difference compared to the placebo passage rate of 47.3% (RR, 1.05; 95.8% CI, 0.87-1.27; p=0.60)
  • No significant difference between treatment groups for any secondary outcomes including rate of surgery, rate of hospitalization, return to the ED for treatment of urinary stones, and proportion of participants who returned to work in 28 days


  • Only 59% of participants received the follow up CT scan to assess for stone passage
  •  They also did not design the study in order to detect a treatment effect of tamsulosin in subgroups based on stone size

 Study 2: Furyk 2016

  • Double-blind, randomized placebo-controlled trial
  • 202 patients were randomized to the tamsulosin group and 201 to the placebo group
  • Stone passage occurred in 87% of the tamsulosin group patients compared to 81.9% in the placebo group, which was a non-significant difference (difference of 5.0%, 95% CI -3.0% to 13.0%, p=0.22)
  • In the large stone subgroup (5-10mm), there was a significant difference in stone passage as the results were 83.3% in the tamsulosin group and 61% in the placebo group (difference of 22.4%, 95% CI 3.1% to 41.6%, p=0.03)


  • 5 patients in the trial reported not receiving any medication at all and many patients (as many as 35% in both groups) admitted to not taking or receiving the medication as instructed
  • Study was done in a single state in Australia and the investigators did not report the race demographics, so it may be hard to generalize the results to some American urban locations
  • Only patients with distal ureteral were included in the study



 1. Meltzer A., Burrows, P., Wolfson, A., et al. Effect of Tamsulosin on Passage of Symptomatic Ureteral Stones: A Randomized Clinical Trial. JAMA Internal Medicine 2018; 178 (8): 1051-1057.

2. Furyk J., Chu, K., Banks, C., et al. Distal Ureteric Stones and Tamsulosin: A Double-Blind, Placebo-Controlled, Randomized, Multicenter Trial. Annals of Emergency Medicine 2016; 67 (1): 86-95.