472 Alpha-blockers effective for ureteral stones

January 02, 2016

written by Brian R McAvoy

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.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.