Wilderness medicine professionals often discuss which medications should be carried on which trips. There’s usually a limit to the size of the medical kit, and precious space must be allotted to the most important items. The painful passage of a kidney stone as it travels down the ureter, enters the bladder, then exits the urinary tract via the urethra, is “epic” for anyone who has ever suffered this event. So, anything that might be helpful to facilitate the stone’s passage or ease the discomfort is a good thing. Tamulosin (Flomax) is a drug that is often prescribed by physicians to promote the passage of a kidney stone(s). It has not quite become “standard of care” to prescribe the drug, but it is increasing in popularity, largely because of the observations by patients and doctors that it seems to help.
This particular study is the first that I have seen that suggests that tamulosin may not be as helpful for this particular purpose as we think. Over a 22 month period, the investigators analysed 100 patients who were able to stay on the protocol, which randomized them to tamulosin or placebo (no active drug), both groups treated with pain medication. The patients needed to have the presence of a stone documented by helical CT scan to be included. The results were informative. There as not difference in pain medication usage between the two groups at days 2, 3 and 7. The percentage of patients who passed a stone within 7 days was 42.2% in the placebo group and 44.2% in the tamulosin group.
It is possible that using tamulosin caused stones to be passed sooner within the 7-day window studied, but this was not reported by the authors, or inferred by any difference in the use of pain medication in the first three days. Also, there would likely need to be more patients enrolled in a similar study before any definitive conclusions can be reached. However, the results suggest that there is a possibility that tamulosin doesn’t have a large influence on ultimate outcome with regard to stone passage, even if it might somewhat hasten the process of passing a stone. I would only carry the drug with me into the wilderness if it were necessary for use by a person for its major indication (enlarged prostate) or if I had space to spare.
image (ouch!) courtesy of the Urology Institute of Nevada
As I mentioned in a previous post, the journal Annals of Emergency Medicine publishes abstracts each year of presentations delivered at the American College of Emergency Physicians Annual Scientific Assembly, which this year was held on Boston. The reference is Annals of Emergency Medicine Volume 54, Number 3, September 2009. One abstract that I found quite interesting and relevant to medicine for the outdoors was entitled “Tamulosin Does Not Increase One-Week Rate of Passage of Ureteral Stones in Emergency Department Patients.”