Date of Graduation

8-15-2009

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Anya Hill

Second Advisor

Rob Rosenow PharmD, OD

Third Advisor

Annjanette Sommers MS, PA-C

Abstract

Background: The impact that distal urolithiasis has on patients can be devastating in terms of discomfort, pain, and overall therapy cost. Traditional first-line treatment for ureteral stone less than 5mm has been conservative therapy consisting of watchful waiting with the main focus placed on pain management. Larger stones in the range of 5mm-10mm have a significantly smaller chance of spontaneous stone expulsion with conservative therapy, many times requiring more invasive therapies such as single wave lithotripsy and uteroscopy. Although these invasive procedures are classified as “minimally invasive”, and have advanced considerably in terms of technology and technique over the past 20 years, they still carry with them risks and a high cost to the patient. Over the years, researchers have isolated an abundance of alpha receptors in the distal ureter similar to those in the male prostate. The blockage of these receptors in the presence of benign prostatic hypertrophy, causes relaxation of the prostate thus increasing the ease by which voiding occurs decreasing the intra-luminal pressure. Likewise, the alpha 1 receptors present in the distal ureter have similar implications to that of the prostate in terms of ureteral relaxation, theoretically increasing the possibility for stone expulsion and reducing renal colic caused by the increased peristaltic movement in the presence of a kidney stone.

Hypothesis: The administration of the off-label use of tamsulosin with traditional conservative urolithiasis therapy will increase the facilitation in the presence of radiographically proven distal ureteral calculi in adults when compared to traditional conservative therapy.

Study Design: Exhaustive search of available medical literature.

Methods: An exhaustive literature search was performed using three main search databases: Medline- Ovid, CINAL, and PubMed. The search terms: Urolithiasis, tamsulosin, and Randomized Controlled trial were used with a limit to retrieve studies published after 2007.

Results: A total of five articles addressing evaluating the use of 0.4mg tamsulosin versus conservative therapy were used during this study. The primary endpoint addressed, was stone expulsion, because of its direct correlation with therapeutic success. Other clinically relevant and important endpoints such as: total time until stone expulsion, pain, and medication side effects were also evaluated in order to appraise the effectiveness of tamsulosin in the presence of distal ureteral stone.

Conclusion: All of the articles evaluating the first-line therapy of tamsulosin in the presence of radiographically proven urolithiasis of less than 1 cm in the adult population illustrated a statistically significant increase in stone expulsion in the 0.4 mg tamsulosin daily administration groups versus conservative therapy groups. Additionally, the secondary endpoints addressed in this study: time to expulsion, pain, and side effects of medication administration demonstrated consistent evidence suggesting positive clinical effectiveness with the use of tamsulosin as a first-line therapy.

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