EBQ:Alpha-blockers for ureteral stone expulsion

Clinical Question

Do alpha-blockers expedite ureteral stone passage?

Pro Argument

  • Current Cochrane Review concludes: "the use of alpha-blockers in adult patients with ureteral stones appears to expedite spontaneous passage, with only minor potential adverse effects."[1][2]
  • There is evidence that the subgroup of large distal stones >5mm benefit from tamulosin (passage rate of 83.3% with tamulosin versus 61.0% with placebo)[3]

Trial 1

Trial 2

Trial 3

Con Argument

  • Although meta-analyses of previous randomized controlled trials concluded that the smooth muscle relaxant drugs tamsulosin and nifedipine assisted stone passage for people managed expectantly for ureteric colic, a randomized placebo-controlled trial demonstrated that no difference was noted between active treatment and placebo (p=0.78), or between tamsulosin and nifedipine (p=0.77).[4][5]


Trial 1

Trial 2

Trial 3

See Also

References

  1. Welch JL and Cooper DD. Systematic review Snapshot. Annals of Emergency Medicine. January 2016. 67(1):117-118.
  2. Campschroer et al. Alpha-blockers as medical expulsive therapy for ureteral stones. Cochrane Databse Syst Rev. 2014(4):CD008509
  3. Furyk, JS, et al. Distal Ureteric Stones and Tamsulosin: A Double-Blind, Placebo-Controlled, Randomized, Multicenter Trial. Annals of Emergency Medicine. 2016; 67(1):86-95.e2.
  4. Singh A, et al. A systematic review of medical therapy to facilitate the passage of ureteral calculi. Annals of Emerg Med. 2007; 552-563.
  5. Pickard R, et al. Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial. Lancet. 2015; epub.

Authors:

Ross Donaldson