alpha blockers

Findings of a recent meta-analysis, published in the British Medical Journal, have revealed that alpha blockers are helpful in the treatment of ureteric stones, especially in patients with larger sized stones.

 

Urinary tract stones are formed from different salts and minerals in the body. Theses stones are prevalent and if large enough, they may cause severe pain in affected individuals.

Aside from the pain, the larger stones may block the urine pathway causing some other serious complications. Stones can form in different places: in kidneys, in the junction between kidneys and ureters, and in ureters. The ureteric stones can be very dangerous in some situations.

The ureter is a thin tube connecting the kidneys to the bladder, and ureteric stones, especially when they are bilateral, can cause renal damage.

Alpha blockers (medications like Terazosin and Prazosin) are now generally used for uncomplicated, newly-diagnosed ureteric stones. They increase the chance of the passage of the stone in most patients, especially with stones smaller than 10 mm.

A large number of trials and meta-analyses have studied the use of alpha blockers in the treatment of ureteric stones. Since most of these studies contain small sample sizes and their results are controversial, the use of alpha blockers for ureteric stones can be debated. To help reconcile these issues, a new systematic review was conducted, identifying all randomized controlled trials examining alpha blockers for treatment of ureteric stones.

This study, which is published in the British Medical Journal, has pooled the data from all randomized placebo-controlled clinical trials comparing the effects of alpha blockers with placebos in the treatment of ureteric stones.

The randomized controlled trials comparing alpha-adrenergic (alpha blockers) with placebo or controls were eligible to be enrolled into this meta-analysis. 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.

This meta-analysis studied 55 clinical trials; the results have shown that there was fair evidence that alpha blockers facilitate the passage of ureteric stones. It seemed that alpha blockers were mostly helpful in patients with larger stones, comparing to those with smaller stones. There was also fair evidence that patients receiving alpha blockers had fewer pain episodes, less surgical interventions, and fewer hospital admissions.

Authors have concluded that alpha blocker treatment is efficacious, especially in patients with large ureteric stones who are eligible for conservative treatment.

 

Written By: Nima Makhdami, M.D.

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