Medical expulsive therapy with alpha-blockers can promote clearance of ureteric stones 5 mm and larger, suggests the findings of a multicenter review of medical literature.
“Alpha-blockers appear to be efficacious in the management of patients with ureteral stones who are eligible for a trial of conservative management, and the benefit appears to be greater to those patients who have larger stones,” first author John M. Hollingsworth, MD, of the University of Michigan Medical School, Ann Arbor told Urology Times.
A 2015 multicenter study in The Lancet (2015; 386:341-9) had questioned the benefit of off-label alpha-blocker use and drew debate around the urologic community. Looking at 1,136 subjects in the United Kingdom, the study found no difference between medical expulsive therapy and placebo. However, a high rate of spontaneous stone passage among controls might better explain those results, Dr. Hollingsworth said.
“Our study was in part a response to the large Lancet trial to sort through some of the information that they had and put it into context of other kidney stone research and published studies that have come out since. The U.K. study wasn’t designed to look at stone size or location, and what we thought is if we are able to pull data from all published studies, we may be able to examine that in more detail,” Dr. Hollingsworth said.
The authors pooled a total of 55 randomized controlled trials comparing alpha-blockers to placebo or control and considered stone size and location in the 5,990 study subjects to see whether either one was a factor in successfully passing the stone.