title: Is there a role for α-blockers in ureteral stent related symptoms? A systematic review and meta-analysis.
abstract: OBJECTIVE
  We evaluated the efficacy of α-blockers to improve ureteral stent related morbidity and quality of life.
  
  
  METHODS
  We performed a search of MEDLINE®, Embase™ and The Cochrane Library plus a hand search of conference proceedings from January 2000 to October 2010 to identify randomized, controlled trials comparing treatment for ureteral stent symptoms with α-blockers. Two reviewers independently screened studies and extracted data. Trial methodological quality was assessed by The Cochrane Collaboration quality assessment tool. Placebo randomized, controlled trials with the ureteral stent symptom questionnaire as the outcome were eligible for meta-analysis. Meta-analysis was done using the mean difference to determine the aggregate effect size.
  
  
  RESULTS
  A total of 12 randomized, controlled trials including 2 α-blockers in a total of 946 patients were eligible, including 4 (33%) presented only as an abstract at a urological meeting and 4 (33%) eligible for meta-analysis. Meta-analysis using a random effects model showed that α-blockers were associated with a significant decrease in urinary symptoms (MD -6.76, 95% CI -11.52 to -2.00, p=0.005), a significant decrease in pain (MD -3.55, 95% CI -5.51 to -1.60, p=0.0004) and significant improvement in general health (MD -1.90, 95% CI -3.05 to -0.75, p=0.001). However, they were not associated with a benefit in work (MD 2.41, 95% CI -1.62 to 6.44, p=0.24) or sexual matters (MD 0.20, 95% CI -1.06 to 1.45, p=0.33). Eight studies were not included in the meta-analysis, of which 7 showed a significant clinical decrease in urinary symptoms and pain.
  
  
  CONCLUSIONS
  Existing evidence from randomized, controlled trials shows that α-blockers are associated with improvement in ureteral stent symptoms and supports their use in routine clinical practice.
authors.affiliation: Department of Urology, Hôpital Huriez, Centre Hospitalier Régional Universitaire, and Department of Biomathematics, Faculty of Pharmacy and Biology, University of Lille 2, Lille, France. rachid.yakoubi@gmail.com
authors.forename: Rachid
authors.initials: R
authors.lastname: Yakoubi
authors.forename: Mohamed
authors.initials: M
authors.lastname: Lemdani
authors.forename: Manoj
authors.initials: M
authors.lastname: Monga
authors.forename: Arnaud
authors.initials: A
authors.lastname: Villers
authors.forename: Philippe
authors.initials: P
authors.lastname: Koenig
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D006801:Humans; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D015607:Stents / Q000009:adverse effects*; D014513:Ureter; D014517:Ureteral Obstruction / Q000601:surgery
chemical_list: D000317:Adrenergic alpha-Antagonists