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Tamsulosin use for suspected urinary stone disease in pregnancy is characterized by empiric prescribing and limited documentation of adherence
Aleksandra M. Golos, BS1, Alejandra Barreto, MPH1, Esther Chung, BS2, Ellen M. Cahill, MD1, Marianne Casilla-Lennon, MD1.
1Yale School of Medicine, New Haven, CT, USA, 2Frank H. Netter School of Medicine at Quinnipiac University, North Haven, CT, USA.
BACKGROUND: Urinary stone disease is a leading non-obstetric cause of hospitalization in pregnancy, though diagnostic and management complexity results in heterogeneous practice patterns. Pregnant women who are candidates for medical expulsive therapy (MET) may be offered tamsulosin. Although its efficacy in facilitating stone passage remains debated, it is acknowledged as an option in AUA guidelines for its benign safety profile in pregnancy. Given limited real-world data, we characterized prescribing patterns and clinical circumstances surrounding tamsulosin use in pregnancy.
METHODS: We identified pregnant patients who were prescribed tamsulosin for suspected urinary stone disease at an academic institution between 2021-2026. Maternal characteristics, diagnostic workup, tamsulosin utilization, and procedural interventions were extracted from the electronic health record.
RESULTS: Sixteen patients (median maternal age 28 years, gestational age 26 weeks) were prescribed tamsulosin during hospital encounters, representing 8.2% of 196 pregnant patients with suspected stone disease. Among patients who received tamsulosin, an obstructing stone was confirmed in only 31% (median size 8.5mm, all identified using ultrasound). Concurrent pyelonephritis was present in 38%. Tamsulosin was prescribed by obstetricians (75%) or emergency medicine physicians (25%), with 50% of initial prescription decisions involving urology. No adverse maternal or fetal events were attributed to tamsulosin, including in two (12%) patients with first-trimester exposure. However, sustained outpatient medication adherence was only documented in 19%. No events of spontaneous stone passage were reported. Procedural intervention was required in six (38%) patients (3 stenting only, 1 stenting with non-definitive ureteroscopy, 1 stenting with ureteroscopy and lithotripsy, 1 percutaneous nephrostomy).
CONCLUSIONS: Tamsulosin use in pregnancy was infrequent and not consistently associated with a thoughtful MET regimen, often without diagnostic confirmation, urologist involvement, or documented medication adherence. These findings highlight the need for multidisciplinary diagnostic and prescribing guidelines and prospective data to better define the role of MET in pregnancy.
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