Letter to the Editior. Re Zhangqun Ye, Guohua Zeng, Huan Yang, et al. Efficacy and Safety of Tamsulosin in Medical Expulsive Therapy for Distal Ureteral Stones with Renal Colic: A Multicenter, Randomized, Double-blind, Placebo-controlled Trial. Eur Urol 2018;73:385–91: Medical Expulsive Therapy for Distal Ureteral Stones: Call the Jury Back

We read with interest the article by Ye et al [1] showing that tamsulosin therapy for stones in the distal ureter (DU) resulted in a higher spontaneous stone passage (SSP) than placebo (difference 7.8%, 95% confidence interval 5.2–10.4%), with a particular benefit for stones of 5–7 mm in size, with similar rates of adverse events in both arms. While meta-analyses of primarily small randomized trials showed a benefit of tamsulosin versus placebo [2], this was thrown into doubt when large, well-designed, randomized studies did not show this benefit [3], [4]. Differences in study design could explain the contrasting results from the published studies.