α-blockers effective in ureteric stone expulsion
α-blockers can increase ureteric stone expulsion and shorten the length of time to expulsion, says a large meta-analysis published in the International Journal of Clinical Practice.
67 studies, randomising 6654 patients, were included in the meta-analysis. Stone expulsion rates improved with α-blockers (RR, 1.49; 95% CI 1.38–1.61) and stone expulsion time was 3.99 days (CI 4.75–3.23) shorter compared to standard therapy or placebo.
Patients required less analgesia and experienced fewer pain episodes.
Acute ureteric stones are a medical emergency and surgical options include lithotripsy and ureteroscopy. α-blockers offer a non-surgical option that can save costs and may be preferred by patients. There has been controversy over the effectiveness of α-blockers in facilitating ureteric stone expulsion. However this study would appear to confirm a benefit.
α-blockers are believed to promote antegrade stone passage and reduce colic by inhibiting the contraction of ureteric smooth muscle. Tamsulosin was used in the majority of studies, however, all α-blockers demonstrated beneficial effects.
Despite the opposing results of recently published trials, current evidence continues to demonstrate a potential benefit of α-blocker treatment particularly for distal stones over 5mm, say the authors.