title: The use of alpha-1 adrenergic blockers in children with distal ureterolithiasis: a systematic review and meta-analysis.
abstract: BACKGROUND
  Urinary lithiasis is the main urologic cause of emergency treatment in adult patient. In the past years, the incidence in children population has increased. However, literature about the use of alpha-1 adrenergic blockers in pediatric population with distal ureterolithiasis is still scarce. The drug acts by decreasing ureter contractions, especially in the distal portion, facilitating calculus expulsion.
  
  
  OBJECTIVE
  This review has the objective to evaluate the use of alpha-1 adrenergic blockers as medical expulsive treatment in children with distal ureterolithiasis.
  
  
  METHODS
  An electronic literature search was performed using the MEDLINE, COCHRANE, and LILACS databases. We further searched manually the references of the primary studies. Searches were concluded on October 4th, 2014. Articles were selected, independently and in pairs, by the respective titles and summaries. Any divergence was resolved by consensus.
  
  
  RESULTS
  Alpha-1 adrenergic antagonists increased the probability of calculus expulsion by 27% (NNT=4). Calculi smaller than 5mm, increased by 33% (NNT=3). Larger than 5mm, increased by 34% (NNT=3).
  
  
  CONCLUSIONS
  Alpha-1 adrenergic blocker use is related with a greater incidence of expulsion of ureteral calculi, smaller or greater than 5mm, and fewer episodes of pain when compared to ibuprofen. However it is necessary larger samples to enhance the power analysis of the expulsion of ureteral calculi larger than 5mm and the episodes of pain.
  
  
  RESULTS
  This review analyzed the outcome of alpha adrenergic antagonist in children with ureteral calculi. We conclude that it is the best medicine for use, since it helps the expulsion of the stone.
authors.affiliation: Faculdade de Ciencias Medicas de Santos, Centro Universitario Lusiada, Santos, Sao Paulo, Brasil.
authors.forename: F P
authors.initials: FP
authors.lastname: Glina
authors.affiliation: Faculdade de Ciencias Medicas de Santos, Centro Universitario Lusiada, Santos, Sao Paulo, Brasil.
authors.forename: P M V
authors.initials: PM
authors.lastname: Castro
authors.affiliation: Faculdade de Ciencias Medicas de Santos, Centro Universitario Lusiada, Santos, Sao Paulo, Brasil.
authors.forename: G G R
authors.initials: GG
authors.lastname: Monteiro
authors.affiliation: Faculdade de Ciencias Medicas de Santos, Centro Universitario Lusiada, Santos, Sao Paulo, Brasil.
authors.forename: G C
authors.initials: GC
authors.lastname: Del Guerra
authors.affiliation: Departamento de Urologia da Faculdade de Medicina do ABC, Santo Andre, Sao Paulo, Brasil.
authors.forename: Sidney
authors.initials: S
authors.lastname: Glina
authors.affiliation: Faculdade de Ciencias Medicas de Santos, Centro Universitario Lusiada, Santos, Sao Paulo, Brasil.|Departamento de Cirurgia Geral do Hospital Guilherme Alvaro, Santos, Sao Paulo, Brasil.
authors.forename: M
authors.initials: M
authors.lastname: Mazzurana
authors.affiliation: Faculdade de Ciencias Medicas de Santos, Centro Universitario Lusiada, Santos, Sao Paulo, Brasil.|Associação Medica Brasileira, São Paulo, Brasil.
authors.forename: W M
authors.initials: WM
authors.lastname: Bernardo
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D002648:Child; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use; D008297:Male; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D053039:Ureterolithiasis / Q000188:drug therapy*
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D018712:Analgesics, Non-Narcotic; D007052:Ibuprofen