Efficacy of alpha-blockers for the treatment of ureteral stones.
OBJECTIVE
We determined if alpha-blocker therapy promotes expulsion of ureteral stones.


METHODS
Meta-analysis was performed of randomized clinical trials of alpha-blockers for the treatment of ureteral stones. The primary outcome was overall stone expulsion rate. Risk ratios and risk differences were estimated using DerSimonian and Laird random effects models.


RESULTS
Eleven trials (911 participants) met inclusion criteria for this study. Pooled analysis demonstrated significantly increased rates of stone expulsion with alpha-blocker therapy. Compared to patients receiving conservative therapy only, patients receiving conservative therapy plus alpha-blockers were 44% more likely to spontaneously expel the stones (RR 1.44, 95% CI 1.31 to 1.59, p<0.001), and stone expulsion incidence increased significantly (RD 0.28, 95% CI 0.22 to 0.34, p<0.001). Sensitivity and subgroup analyses categorized by specific alpha-blocker, prior use of shock wave lithotripsy and stone size produced similar effect estimates, but were generally less precise due to smaller sample sizes. The largest subgroup of trials (664 participants) studied tamsulosin without prior shock wave lithotripsy (RR 1.44, 95% CI 1.32 to 1.58; RD 0.29, 95% CI 0.23 to 0.35).


CONCLUSIONS
alpha-Blocker therapy is associated with significantly increased rates of distal ureteral stone expulsion.
Parsons
J Kellogg
JK
Division of Urology, University of California San Diego School of Medicine, San Diego, California 92103, USA. jkparsons@ucsd.edu
Hergan
Lori Ann
LA
Sakamoto
Kyoko
K
Lakin
Charles
C
D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D006801:Humans; D008096:Lithotripsy; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000188:drug therapy*
D000317:Adrenergic alpha-Antagonists