Clinical question
How effective are alpha-blockers in adult patients presenting with symptoms of ureteral stones measuring less than 10mm confirmed by imaging?
Bottom line
Compared with standard therapy, calcium channel blockers or placebo, alpha-adrenergic blockers resulted in a higher stone-free rate and a shorter time (2.91 days) to expulsion, and therefore decreased the duration of symptoms and rate of complications (urinary tract infection, hydronephrosis and impairment of kidney function). Alpha-blockers slightly reduced the number of pain episodes and the need for analgesic medication and hospitalisation. Side effects were more present in the alpha-blockers group; most adverse effects were mild and did not lead to cessation of therapy.
Caveat
Of the 32 studies, 29 involved patients with distal ureteric stones. In only 7 studies were patients and doctors both blinded. In the other studies, blinding was not described in the methods or no blinding had taken place. Two studies described incomplete data, and only 1 study showed a relatively high number of patients who withdrew from the study. These factors limited the methodological strength of the evidence found.
Context
Urinary stone disease is relatively common, affecting about 5–10% of the population. Annual costs for stone disease have rapidly increased over the years, and most patients with ureteral colic or other symptoms seek medical care.
Cochrane Systematic Review
Campschroer T et al. Alpha-blockers as medical expulsive therapy for ureteral stones. Cochrane Reviews, 2014, Issue 4. Art. No.: CD008509.DOI: 10.1002/14651858. CD008509.pub2. This review contains 32 studies involving 5864 participants.
Cochrane Systematic Reviews for primary care practitioners
Developed by the Cochrane Primary Care Field, New Zealand Branch of the Australasian Cochrane Centre at the Department of General Practice and Primary Health Care, University of Auckland and funded by the Ministry of Health and New Zealand Doctor. PEARLS are meant for educational use and not to guide clinical care. New Zealanders can access the Cochrane Library free via www.cochrane.org.nz
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