This was a retrospective analysis of data for five years from four institutions comparing stone passage rates in children with ureteric stones ≤10mm, aged 2-18, treated with tamsulosin vs. analgesia alone. The study identified 449 children, of whom 334 were eligible and 274 had complete data. Exclusion criteria were infection, single kidney, immunocompromised state, renal failure, stones >10mm, previous surgery for renal or ureteric stones and early surgical intervention. Ninety-nine children received tamsulosin (400mcg). There was no specific selection criteria for those who received it, but the time period chosen coincided with a more widespread acceptance of the concept of medical expulsive therapy and increasing evidence from the adult literature. Comparison was made with both 175 children treated with analgesics alone, and a sub-group of 99 patients who were propensity matched to the tamsulosin group based on age, size, gender, weight, height, stone size and stone location (upper, middle and lower third). Stone passage was described as radiologically confirmed or patient reported passage within six weeks. Children received surgical intervention for uncontrolled pain or repeated Emergency Department attendances. When the whole groups were analysed there was a 58 vs. 41% difference in stone passage rates favouring the tamsulosin group. However, the children in this group were older and taller, with smaller and more distal stones. In the comparison with the propensity matched group, the effect of additional tamsulosin was decreased, although stone passage with tamsulosin vs. analgesia alone was still 55 vs. 44% (p=0.03). Strengths: this is the largest group of children in whom medical expulsive therapy has ever been studied. There were no reported adverse events, confirming the safety of use. Limitations: the retrospective nature of the study means there was heterogeneity regarding imaging modality used for diagnosis and the lack of confirmation of stone passage. There was also no clarification for duration of tamsulosin treatment or patient compliance with this. The study was powered to detect a 15% difference, which it could not show. Overall this confirms the safe use of medical expulsive therapy in children, provided there are strict criteria for its use and close follow-up to confirm stone passage.
Tamsulosin and spontaneous passage of ureteral stones in children
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