Investigators evaluate tamsulosin use in pediatric patients

In a recent study, investigators evaluated the use of tamsulosin (Flomax) in pediatric patients undergoing ureteroscopy.¹ They reported that patients who received tamsulosin had an 87% chance of having a successful URS procedure, according to senior author Kate H. Kraft, MD, MHPE, FACS, FAAP.

The study findings indicate a significant age and body mass index difference between the tamsulosin and the no-tamsulosin groups. In an interview with Urology Times®, Kraft was asked how she believed these factors might independently or interactively influence ureteral access and the observed tamsulosin efficacy.

“We definitely found a significant difference in the 2 groups. I think that comes with the limitation of this being retrospective. It looked like those who were in the tamsulosin group were taller, they weighed more, they had a larger BMI, and they were older. I think a lot of that has to do with prescribing practices among our colleagues. We feel very comfortable, in general, prescribing tamsulosin in older patients, because it's a capsule so they can swallow it, although the counter argument to that is you can't open the capsule and sprinkle the contents for children whodon't take pills,” said Kraft, chief of Pediatric Urology, Mark C. McQuiggan, MD, and Carolyn A. McQuiggan Research Professor, and professor of urology at the University of Michigan, Ann Arbor.

Kraft also touched on the role of prescriber comfort and potential adverse events.

“Tamsulosin is associated with some possibility of hypertension or dizziness, and I think in a younger cohort, where it's more difficult to adjust the dose, pediatric urologists just don't feel as comfortable prescribing it,” Kraft said.

Kraft was also asked about the fact that although their findings demonstrated a statistically significant improvement in ureteroscopic access with tamsulosin, the absolute risk reduction was 11%.

“We recognize that an 11% increase in success may not seem that clinically significant, but I think every little bit helps. When we are unable to advance a flexible ureteroscope in a pediatric patient, really, the next alternative is to place a ureteral stent for passive dilation, and then that means another trip to the operating room in the future to make another attempt. And that's no small thing,” Kraft commented.

REFERENCE

1. Meyer KM, Asantey K, Ellison JS, et al. The effect of preoperative tamsulosin on pediatric ureteroscopic access: A multi-institutional experience. Urol Pract. 2025 Feb 5:101097UPJ0000000000000793. doi:10.1097/UPJ.0000000000000793