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What makes renal stones fly out of your urine stream? Not tamsulosin nor nifedipine, it appears.
Based on: Pickard R et al. Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial. Lancet May 19, 2015
So we've seen a few articles in the last couple of years citing tamusolin no better than placebo for MET. What none of these articles care to address is that tamusolin decreases ureteral spasm and therefore, pain. THIS is what causes patients to bounceback to the the ED. We all know what stones are likely to require urologic intervention, ie. size, location, etc. and which ones will likely pass on their own. If tamusolin has no effect on stone passage, quite frankly, I'm not concerned. I'd like to see a stone study whose primary outcome is failure of outpatient treatment: tamusloin+standard therapy (nsaids, narcotics, antiemetics) vs standard therapy alone. If it's shown that tamusolin does nothing to improve pain control and prevent bouncebacks, THEN I'm ready to kiss it goodbye. Until then, I'll continue to prescribe with the belief that I will be achieving better pain control for my patients, and preventing bouncebacks.Juan MD
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