Short Attention Span Summary
It works. No it doesn’t. Yes it does…
This is one of the largest meta-analyses I have seen to date, with 55 RCTs, that provides some clarity about alpha blockers for kidney stones. Similar to prior meta-analyses, this one also found that alpha blockers help stone passage, but only larger stones. And alpha blockers had other benefits: reduced pain, shorter time to passage, reduced surgery, and decreased admission. Plus there did not seem to be an increase in adverse events, like orthostatic hypotension.
Pooling lots of studies, it looks like alpha blockers for larger kidney stones provide significant benefit with a low risk profile.
BMJ. 2016 Dec 1;355:i6112. doi: 10.1136/bmj.i6112.
1Department of Urology, University of Michigan, 2800 Plymouth Rd, Building 16, 1st Floor, Ann Arbor, MI 48109, USA firstname.lastname@example.org.
2Department of Urology, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610, USA.
3Department of Internal Medicine, Division of General Medicine, University of Michigan, 2800 Plymouth Rd, Building 16, 4th Floor, Ann Arbor, MI 48109, USA.
4Minneapolis Veterans Administration Health Care System and Department of Urology, University of Minnesota, Mayo Memorial Building, 420 Delaware St SE, MMC 394, Minneapolis, MN 55455, USA.
5Department of Urology, University of Michigan, 2800 Plymouth Rd, Building 16, 1st Floor, Ann Arbor, MI 48109, USA.
6Borland Library, University of Florida, 653-1 W 8th St, Jacksonville, FL 32209, USA.
To investigate the efficacy and safety of alpha blockers in the treatment of patients with ureteric stones.
Systematic review and meta-analysis.
Cochrane Central Register of Controlled Trials, Web of Science, Embase, LILACS, and Medline databases and scientific meeting abstracts to July 2016.
Randomized controlled trials of alpha blockers compared with placebo or control for treatment of ureteric stones were eligible. : Two team members independently extracted data from each included study. The primary outcome was the proportion of patients who passed their stone. Secondary outcomes were the time to passage; the number of pain episodes; and the proportions of patients who underwent surgery, required admission to hospital, and experienced an adverse event. Pooled risk ratios and 95% confidence intervals were calculated for the primary outcome with profile likelihood random effects models. Cochrane Collaboration’s tool for assessing risk of bias and the GRADE approach were used to evaluate the quality of evidence and summarize conclusions.
55 randomized controlled trials were included. There was moderate quality evidence that alpha blockers facilitate passage of ureteric stones (risk ratio 1.49, 95% confidence interval 1.39 to 1.61). Based on a priori subgroup analysis, there seemed to be no benefit to treatment with alpha blocker among patients with smaller ureteric stones (1.19, 1.00 to 1.48). Patients with larger stones treated with an alpha blocker, however, had a 57% higher risk of stone passage compared with controls (1.57, 1.17 to 2.27). 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 (mean difference -3.79 days, -4.45 to -3.14; moderate quality evidence), fewer episodes of pain (-0.74 episodes, -1.28 to -0.21; low quality evidence), lower risks of surgical intervention (risk ratio 0.44, 0.37 to 0.52; moderate quality evidence), and lower risks of admission to hospital (0.37, 0.22 to 0.64; moderate quality evidence). The risk of a serious adverse event was similar between treatment and control groups (1.49, 0.24 to 9.35; low quality evidence).
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.
SYSTEMATIC REVIEW REGISTRATION:
PROSPERO registration No CRD42015024169.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
PMCID: PMC5131734 Free PMC Article
PMID: 27908918 [PubMed – in process]