Parsons JK et al. (2007) Efficacy of α-blockers for the treatment of ureteral stones. J Urol 177: 983–987

Urolithiasis is usually treated with the expensive procedures shock-wave lithotripsy and ureteroscopy. Recent trials have suggested that α-blockers can cause selective relaxation of ureteral smooth muscle and consequently spontaneous distal ureteral stone expulsion.

A meta-analysis of randomized clinical trials of α-blocker therapy performed by Parsons et al. has demonstrated that α-blocker therapy does significantly increase the incidence of distal ureteral stone expulsion (P <0.001). The authors performed their analysis by conducting separate searches of 4 different databases. Overall stone expulsion rate was the primary outcome, and only patients with stones or fragments located in the distal part of the ureter were included. The search results provided 11 studies that met the criteria for analysis, a total of 911 patients.

Patients who were treated with the α-blocker tamsulosin (0.4 mg), terazosin (5 mg), or doxazosin (4 mg), daily for a mean of 24 days, were 44% more likely to expel ureteral stones than patients who received fluid and pain control therapy alone (P <0.001). Subgroup analyses established that α-blocker type, previous treatment with shock-wave lithotripsy, stone size and concomitant corticosteroid use did not significantly alter the positive effect of α-blockers on stone expulsion.

The authors conclude that treatment with α-blockers results in significantly increased rates of expulsion of ureteral stones. Publication bias, resulting in overestimation of the effect of treatment, could be a potential limitation of the study.