Title: Alpha‐blockers as medical expulsive therapy for ureteral stones
Type of Article: Systemic Review
Citation: Campschroer T, Zhu X, Vernooij RW, Lock MT. Alpha-blockers as medical expulsive therapy for ureteral stones. Cochrane Database Syst Rev. 2018 Apr 5;4(4):CD008509. doi: 10.1002/14651858.CD008509.pub3. PMID: 29620795; PMCID: PMC6494465.
Treatment of Outcome Studied: Are Alpha-blockers effective in improving stone passages?
Inclusion Criteria: In this systemic review authors conducted a review of 67 studies that included a total of 10,509 participants overall.
Summary:
Expulsion Time: Authors found that treatment with alpha-blockers can result in a large increase in stone clearance when compared to placebo. Stone clearance was found to occur 3.4 days sooner with alpha-blockers when compared to placebo. 95% confidence interval (CI) . The authors also found that alpha-blockers work differently depending on stone size, and they found that alpha-blockers work better on larger stones compared to 5mm or smaller. Also, the authors found no difference in alpha-blockers.
Pain: Treatment with alpha-blocker may help reduce episodes of pain, but the quality of evidence is low. However, it was found that patients who took alpha-blocker were less likely to need the use of diclofenac.
Side effects: Usage of tamsulosin, alfuzosin, doxasozin, terazosin, naftopidil, and silodosin did not cause any major-side effects, and are safe for patients to take to help with expulsion of kidneys tones.
Limitations: The authors only compared alpha-blockers to placebo, and diclofenac for pain. However, Calcium channel blocker nifedipine has also been found to help patients with expulsion of kidney stones. A direct comparison between alpha-blocker, and nifedipine would help providers know if they are providing the best medication to treat patients with kidney stones.
Conclusion: Current guidelines recommend that Tamsulosin can be used to help patients with kidney stones that are 5mm or smaller. However, the authors found low-evidence in their meta-analysis, and downgraded all RCT they did a systemic-review on. Majority of studies the authors analyzed were done against placebo and had publication bias. Additionally, patients who have larger than 5mm stones maybe have the most benefit of using alpha-blocker. Even though alpha-blockers are safe, it may be time to re-think if prescribing patients with alpha-blocker are effective way of helping patients expel kidney stones, especially since majority of kidney stones that are 5mm or less can pass on their own.
