Alpha-blockers as medical expulsive therapy for ureteral stones
Campschroer, Thijs, et al. “Alpha‐blockers as medical expulsive therapy for ureteral stones.” The Cochrane Library (2014).
Alpha-blockers tend to decrease intra-ureteral pressure and increase fluid passage which might increase stone passage. The hope is that faster stone expulsion will decrease the rate of complications, such as the need for invasive surgical interventions and eventually decrease overall healthcare costs.
The Cochrane Collaboration searched literature consisting of all randomized controlled trials (RCTs), which compared alpha-blockers with other pharmacotherapy or placebo on ureteral stone passage in adult patients. Thirty-two studies (5864 participants) were included.
Outcome Measure: Impact on stone clearance rate, in adult patients presenting with symptoms of ureteral stones less than 10 mm confirmed by imaging
The stone-free rates were significantly higher in the alpha-blocker group when compared to standard therapy. Stone expulsion time was 2.91 days shorter with the use of alpha-blockers. Use of alpha-blockers reduced the number of pain episodes, the need for analgesic medication, and hospitalization. Patients using alpha-blockers were more likely to experience adverse effects when compared to standard therapy or placebo.
The use of alpha-blockers in patients with ureteral stones results in a higher stone-free rate and a shorter time to stone expulsion. Alpha-blockers could reasonably be offered as a part of the primary treatment modalities.
Most studies have a relatively small number of patients, are performed in a single-center, and have variable methodological quality. Therefore it can be argued that a large-scale, placebo-controlled RCT may be needed to draw final conclusions concerning the role of alpha-blockers in all ureteral stones.