Please select the eligibility criteria that correspond to the clinical trial below.
Title: Study of Tamsulosin for Urolithiasis in the Emergency Department
Brief Summary: Urolithiasis is a disease that effects 12% of the population and its incidence is growing. In the US there are over 1.1 million visits annually to Emergency Departments for renal colic. The disease is extremely painful, often requiring large amounts of narcotic analgesia, and results in lost work days. Moreover, up to 30% of patients may eventually require lithotripsy or surgical removal of the stone. Currently there are no medical interventions other than analgesia which are offered to patients.

Based on encouraging results from several small European clinical studies, the researchers hypothesize that the administration of tamsulosin to patients with symptomatic urolithiasis will enhance stone passage, and reduce both the time to recovery and the need for surgical intervention or lithotripsy. The researchers will conduct a study by identifying and recruiting patients presenting with urolithiasis in the emergency departments of four institutions.

A total of 500 consenting subjects will be randomly assigned to one of two groups:

1. tamsulosin for a maximum of 28 days;
2. placebo for a maximum of 28 days.

In addition, both groups will receive standard analgesic therapy.

The study team, which will be blinded to treatment status, will monitor each subject's clinical progress and outcome. The primary objectives of this study are:

1. to determine if tamsulosin is effective, and
2. to evaluate the safety of the therapy.

Another objective is to identify the most appropriate clinical subgroup(s) for treatment.

If the therapeutic benefits observed in smaller clinical studies are replicated, administration of these medications should produce several benefits, including:

1. a reduction in time to pain free recovery and hence a more rapid return to employment;
2. decreased requirements for narcotic analgesia;
3. less need for urological out-patient clinic follow-up;
4. decreased need for surgical intervention or lithotripsy; and
5. substantial cost savings.

If this therapy is beneficial, it will represent a major advance in the treatment of urolithiasis. This objective is a major stated goal of the NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases) Clinical Urology Program, which has a stated mission to improve the treatment of urolithiasis.

Kidney stones are a major public health issue, and one person in eight will be affected by the disease. If the hypothesis is verified, the researchers will provide the first medical therapy ever for this disease. This therapy, if effective, will reduce the amount of time a patient is off work because of the pain from the disease, and may also reduce the need for expensive and time-consuming surgical treatments.


Options:
A: Inclusion Criteria:

* Patients of both sex with age greater than 18 years to 90 years
* Stone burden between 10 and 20 mm diagnosed by CT scan
* Patient must be agreeable to randomization between shock wave lithotripsy and percutaneous stone removal

Exclusion Criteria:

* Patients with bleeding diathesis or taking anti-platelet or anti-coagulant medication
* Patients who are pregnant based on routine pre-operative pregnancy testing
* Patients with skin to stone size greater than 12 cm (measured routinely on CT scan)
* Patients with either Horseshoe kidney, transplant kidney or a solitary kidney
* Patients with ureteral calculi
* Patients with stone size of \< 10 mm and \> 20 mm
* Ureteropelvic junction obstruction
B: Inclusion Criteria:

* Patient 18 years or older
* Stones ≥ 2 cm and/or mild to moderate hydronephrosis.

Exclusion Criteria:

* Age \<18 years or Pregnancy
* Bilateral simultaneous PCNL
* Morbid obesity (BMI \>40)
* Refuse to complete study requirements
* Untreated UTI
* Atypical bowel interposition by CT
* Tumour in the presumptive access tract area or Potential malignant kidney tumour
C: Inclusion Criteria:

1. Age ≥ 18 years
2. Evidence of ureterolithiasis (i.e. stone is located in ureter, not in bladder) as demonstrated on radiographic studies, specifically non-contrast spiral CT.
3. Willingness to participate and able to proceed with standard outpatient management (no personal or job-related issues, e.g. airline pilot.
4. Has a telephone in order to be contacted for follow-up.

Exclusion Criteria:

1. Patient desiring or requiring immediate surgical intervention making then not a candidate for outpatient kidney stone management.
2. Current urinary tract infection based on urine dipstick as admission and urgent procedural management are likely indicated.
3. Known anatomical genitourinary abnormalities or prior Genitourinary surgeries.
4. Positive pregnancy test making proper radiological imaging contraindicated.
5. Breastfeeding mothers.
6. History of hypersensitivity to tamsulosin.
7. Current use of alpha blockers or calcium channel blockers.
8. Current use of steroids which may have an independent effect on stone expulsion.
9. Spontaneous stone expulsion prior to enrollment.
10. Largest stone dimension ≥ 9mm assessed using radiologic imaging, being very unlikely to pass spontaneously.
11. Presence of stone in the bladder.
12. Current use of vardenafil which is tamsulosin contraindicated.
13. Ipsilateral, transplanted or solitary kidney as hospitalization may be necessary.
14. Known renal insufficiency.
15. Fever defined as \>101.5°F which may indicate infection.
16. Floppy iris syndrome which is tamsulosin contraindicated.
17. Planned cataract surgery in the next 60 days which is tamsulosin contraindicated.
18. Prisoners /wards of state.
19. Prior enrollment in STONE (Candidates who are screened and found ineligible may be rescreened at a later date.)
D: Inclusion Criteria:

1. 10-20mm lower pole renal stone measured by KUB or CT;
2. Age between 18-60 years, no gender limitation;
3. Participators can understand the research and sign the consent form without mental illness nor language disorder;
4. Low pole renal stone left after lithotripsy;
5. Lower pole infundibulopelvic angle which measured by IVP or CTU will less than 30 degree;
6. Asymptomatic patients with positive urine white blood cells and negative preoperative urine culture should be treated with antibiotics for 3days before operation;
7. Patients with symptoms of urinary infections, positive urine withe blood cells and positive preoperative urine culture should be treated with suitable antibiotics based on the culture sensitivity result for at least 7days before operation.

Exclusion Criteria:

1. Transplant kidney stone;
2. Renal malformations, such as UPJO, medullary sponge kidney, polycystic kidney, horseshoe kidney, etc.;
3. Combine other part of urinary stones need to be handle at the same procedure, for example ureteral stone, renal pelvic stone, middle or upper pole renal stone;
4. Hematological Disease or Coagulation disorders;
5. Withdraw anticoagulant medicine less than two weeks;
6. Fever or urinary infections without treatment according to the inclusion criteria;
7. Sevier renal dysfunction(endogenous creatinine clearance rate≤50ml/min)
8. Middle or severe hydronephrosis(dilatation of the renal pelvis ≥20mm by ultrasound);
9. Women in menstrual period or pregnancy;
10. Patients have severe disease, such as heart disease, lung dysfunction, and multiple organ failure that cannot tolerate anesthesia or operation.

Answer: C