Using Flomax for ureteral stones has been a controversial topic. A meta-analysis of 8 randomized controlled trials consisted of 1,384 patients showed that there was no benefit in giving Flomax to those with ureteral stones < 5mm. However, Flomax was beneficial for patients with stones > 5mm (risk difference=22%; 95% confidence interval 12% to 33%; number needed to treat=5). Flomax did not increase the incidence of dizziness or orthostatic hypotension in the 8 trials.

Take home point: We should consider discharging patients with ureteral stones > 5mm with Flomax.

Wang, R.C., et al. Effect of Tamsulosin on Stone Passage for Ureteral Stones: A Systematic Review and Meta-analysis. Annals of emergency medicine 2017;69(3):353-361.e353.