Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Alpha Blockers & Treatment of Ureteric Stones

BMJ; ePub 2016 Dec 1; Hollingsworth, et al

The use of alpha blockers for the treatment of ureteric stones is effective in patients who are amendable to conservative management, a recent study found. The meta-analysis examined 55 randomized controlled trials of alpha blockers compared with placebo or control for the treatment of ureteric stones. Primary outcomes was the proportion of patients who passed their stone. Researchers found:

  • Moderate quality evidence was observed that alpha blockers facilitate passage of ureteric stones (RR, 1.49).
  • The greatest benefit may be among patients with larger stones (57% higher likelihood of stone passage vs controls).
  • The effect of alpha blockers was independent of stone location.
  • Compared with controls, patients receiving alpha blockers had significantly shorter times to stone passage, fewer episodes, lower risks of surgical intervention, and lower risk of admission to hospital.

Citation:

Hollingsworth JM, Canales BK, Rogers MA, et al. Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis. [Published online ahead of print December 1, 2016]. BMJ. doi:10.1136/bmj.i6112.

Commentary:

Urinary stones are common, with a prevalence of about 5% in the population. Non-contrast CT scan is the diagnostic modality of choice. When calculi are smaller than 5 mm, 90% will pass spontaneously, but as stones approach 1 cm, there is less than a 10% chance that they will pass.1 Since small stones pass spontaneously almost all of the time, alpha-blockers add little to the management of these small stones. The value of alpha-blockers is for stones of 5 mm to 10 mm in size, where the use of an alpha-blocker significantly improves the rate of passage without surgical intervention. —Neil Skolnik, MD

  1. Pietrow PK. Medical management of common urinary calculi. Am Fam Physician. 2006;74:86-94, 99-100.