Paul S. Mueller, MD, MPH, FACP reviewing Hollingsworth JM et al. BMJ 2016 Dec 1.

Especially among patients with large stones, passage is faster and less painful with α-blockers.

Evidence is mixed on whether α-blockers, such as tamsulosin, doxazosin, and terazosin, promote passage of ureteral stones (kidney stones that have migrated into the ureters). In this meta-analysis of 55 randomized controlled trials, researchers determined the efficacy and safety of α-blockers in treating patients with ureteral stones.

Participants were 6000 people (mean age, 40) with ureteral stones (mean size, 5.7 mm). Intervention groups received α-blockers (usually tamsulosin) and control groups received no treatment to promote stone passage (14 trials were placebo-controlled). Participants who received α-blockers were significantly more likely to pass stones (follow-up, 1–6 weeks): Rates of stone passage were roughly 75% with α-blockers and 50% in control groups. The benefit of α-blockers was more evident for large stones than for small stones; because different studies used different cutoffs for large versus small stone size, no specific size threshold was given. Participants who received α-blockers had shorter mean time to stone passage (9 vs. 13 days), fewer pain episodes (0.7 episodes fewer), and lower risks for requiring surgical intervention and hospitalization. The effect of α-blockers was independent of stone location.

CITATION(S):

Hollingsworth JM et al. Alpha blockers for treatment of ureteric stones: Systematic review and meta-analysis. BMJ 2016 Dec 1; 355:i6112.

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