The controversy continues over whether alpha-blockers facilitate the passage of kidney stones.
Tamsulosin or other alpha-blockers are commonly used to relax the ureters to help pass renal stones...but the evidence is conflicting.
That's probably because stone size matters.
Most stones smaller than a pencil eraser (5 mm) pass on their own.
But new evidence suggests that alpha-blockers are helpful for larger stones...from 5 mm up to the size of a plain M&M's candy (10 mm).
About one more in 5 patients will pass these larger stones...and stones may pass a few days faster...when an alpha-blocker is used for 4 weeks compared to placebo.
Explain that patients with larger stones or stones that don't pass may need lithotripsy or other procedures to crush or remove the stone.
Recommend scheduled NSAIDs for pain. They decrease ureteral spasms and work at least as well as opioids. In fact, NSAIDs are better than opioids at reducing the need for rescue pain meds and hospitalizations.
For more details, see our commentary, Passing Kidney Stones...and give patients our handout, How Can I Prevent Another Kidney Stone?
- Ann Emerg Med 2016;67(1):86-95.e2
- Ann Emerg Med 2016;67(4):449-54
- Ann Emerg Med Published online Sep 7, 2016; doi:10.1016/j.annemergmed.2016.06.044
- Commentary: Passing Kidney Stones: Do Alpha-Blockers Help?
- Patient Education: How Can I Prevent Another Kidney Stone?