The latest practice guidelines from leading professional societies recognize the off-label use of alpha adrenergic antagonists (or alpha blockers) as an initial treatment option for patients with newly diagnosed, uncomplicated ureteric stones <10 mm in size, whose symptoms are controlled. This is based on several systematic reviews and meta-analyses of numerous randomized controlled trials, which, in aggregate, showed a higher rate of stone passage among patients treated with alpha blockers (their use has been termed medical expulsive therapy) compared with controls. Consequently, such treatment has become part of the routine management algorithm for ureteric colic.
A study conducted by John M Hollingsworth et al, in order to investigate the efficacy and safety of alpha blockers in the treatment of patients with ureteric stones was published in The BMJ,01 December 2016.
55 randomized controlled trials were included. There was moderate quality evidence that alpha blockers facilitate passage of ureteric stones . Based on a priori subgroup analysis, there seemed to be no benefit to treatment with alpha blocker among patients with smaller ureteric stones. Patients with larger stones treated with an alpha blocker, however, had a 57% higher risk of stone passage compared with controls. 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, fewer episodes of pain, lower risks of surgical intervention, and lower risks of admission to hospital. The risk of a serious adverse event was similar between treatment and control groups.
Thus the researchers concluded that 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.
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