title: Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis.
abstract: OBJECTIVE
  To investigate the efficacy and safety of alpha blockers in the treatment of patients with ureteric stones.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Cochrane Central Register of Controlled Trials, Web of Science, Embase, LILACS, and Medline databases and scientific meeting abstracts to July 2016.
  
  
  METHODS
  Randomized controlled trials of alpha blockers compared with placebo or control for treatment of ureteric stones were eligible. : Two team members independently extracted data from each included study. The primary outcome was the proportion of patients who passed their stone. Secondary outcomes were the time to passage; the number of pain episodes; and the proportions of patients who underwent surgery, required admission to hospital, and experienced an adverse event. Pooled risk ratios and 95% confidence intervals were calculated for the primary outcome with profile likelihood random effects models. Cochrane Collaboration's tool for assessing risk of bias and the GRADE approach were used to evaluate the quality of evidence and summarize conclusions.
  
  
  RESULTS
  55 randomized controlled trials were included. There was moderate quality evidence that alpha blockers facilitate passage of ureteric stones (risk ratio 1.49, 95% confidence interval 1.39 to 1.61). Based on a priori subgroup analysis, there seemed to be no benefit to treatment with alpha blocker among patients with smaller ureteric stones (1.19, 1.00 to 1.48). Patients with larger stones treated with an alpha blocker, however, had a 57% higher risk of stone passage compared with controls (1.57, 1.17 to 2.27). The effect of alpha blockers was independent of stone location (1.48 (1.05 to 2.10) for upper or middle stones; 1.49 (1.38 to 1.63) for lower stones). Compared with controls, patients who received alpha blockers had significantly shorter times to stone passage (mean difference -3.79 days, -4.45 to -3.14; moderate quality evidence), fewer episodes of pain (-0.74 episodes, -1.28 to -0.21; low quality evidence), lower risks of surgical intervention (risk ratio 0.44, 0.37 to 0.52; moderate quality evidence), and lower risks of admission to hospital (0.37, 0.22 to 0.64; moderate quality evidence). The risk of a serious adverse event was similar between treatment and control groups (1.49, 0.24 to 9.35; low quality evidence).
  
  
  CONCLUSIONS
  Alpha blockers seem efficacious in the treatment of patients with ureteric stones who are amenable to conservative management. The greatest benefit might be among those with larger stones. These results support current guideline recommendations advocating a role for alpha blockers in patients with ureteric stones.
  
  
  BACKGROUND
  PROSPERO registration No CRD42015024169.
authors.affiliation: Department of Urology, University of Michigan, 2800 Plymouth Rd, Building 16, 1st Floor, Ann Arbor, MI 48109, USA kinks@med.umich.edu.
authors.forename: John M
authors.initials: JM
authors.lastname: Hollingsworth
authors.affiliation: Department of Urology, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610, USA.
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Canales
authors.affiliation: Department of Internal Medicine, Division of General Medicine, University of Michigan, 2800 Plymouth Rd, Building 16, 4th Floor, Ann Arbor, MI 48109, USA.
authors.forename: Mary A M
authors.initials: MA
authors.lastname: Rogers
authors.affiliation: Minneapolis Veterans Administration Health Care System and Department of Urology, University of Minnesota, Mayo Memorial Building, 420 Delaware St SE, MMC 394, Minneapolis, MN 55455, USA.
authors.forename: Shyam
authors.initials: S
authors.lastname: Sukumar
authors.affiliation: Department of Urology, University of Michigan, 2800 Plymouth Rd, Building 16, 1st Floor, Ann Arbor, MI 48109, USA.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Yan
authors.affiliation: Borland Library, University of Florida, 653-1 W 8th St, Jacksonville, FL 32209, USA.
authors.forename: Gretchen M
authors.initials: GM
authors.lastname: Kuntz
authors.affiliation: Minneapolis Veterans Administration Health Care System and Department of Urology, University of Minnesota, Mayo Memorial Building, 420 Delaware St SE, MMC 394, Minneapolis, MN 55455, USA.
authors.forename: Philipp
authors.initials: P
authors.lastname: Dahm
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D014514:Ureteral Calculi / Q000188:drug therapy*
chemical_list: D000317:Adrenergic alpha-Antagonists