Medical therapy to facilitate urinary stone passage: a meta-analysis.
BACKGROUND
Medical therapies to ease urinary-stone passage have been reported, but are not generally used. If effective, such therapies would increase the options for treatment of urinary stones. To assess efficacy, we sought to identify and summarise all randomised controlled trials in which calcium-channel blockers or alpha blockers were used to treat urinary stone disease.


METHODS
We searched MEDLINE, Pre-MEDLINE, CINAHL, and EMBASE, as well as scientific meeting abstracts, up to July, 2005. All randomised controlled trials in which calcium-channel blockers or alpha blockers were used to treat ureteral stones were eligible for inclusion in our analysis. Data from nine trials (number of patients=693) were pooled. The main outcome was the proportion of patients who passed stones. We calculated the summary estimate of effect associated with medical therapy use using random-effects and fixed-effects models.


RESULTS
Patients given calcium-channel blockers or alpha blockers had a 65% (absolute risk reduction=0.31 95% CI 0.25-0.38) greater likelihood of stone passage than those not given such treatment (pooled risk ratio 1.65; 95% CI 1.45-1.88). The pooled risk ratio for alpha blockers was 1.54 (1.29-1.85) and for calcium-channel blockers with steroids was 1.90 (1.51-2.40). The proportion of heterogeneity not explained by chance alone was 28%. The number needed to treat was 4.


CONCLUSIONS
Although a high-quality randomised trial is necessary to confirm its efficacy, our findings suggest that medical therapy is an option for facilitation of urinary-stone passage for patients amenable to conservative management, potentially obviating the need for surgery.
Hollingsworth
John M
JM
Department of Urology, Ann Arbor Veterans Affairs Health Services Research & Development Center of Excellence, Ann Arbor, MI, USA.
Rogers
Mary A M
MA
Kaufman
Samuel R
SR
Bradford
Timothy J
TJ
Saint
Sanjay
S
Wei
John T
JT
Hollenbeck
Brent K
BK
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000328:Adult; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014545:Urinary Calculi / Q000188:drug therapy* / Q000473:pathology
D000305:Adrenal Cortex Hormones; D000317:Adrenergic alpha-Antagonists; D002121:Calcium Channel Blockers