Efficacy of α-Blockers for the Treatment of Ureteral Stones

PurposeWe determined if α-blocker therapy promotes expulsion of ureteral stones.Materials and MethodsMeta-analysis was performed of randomized clinical trials of α-blockers for the treatment of ureteral stones. The primary outcome was overall stone expulsion rate. Risk ratios and risk differences were estimated using DerSimonian and Laird random effects models.ResultsEleven trials (911 participants) met inclusion criteria for this study. Pooled analysis demonstrated significantly increased rates of stone expulsion with α-blocker therapy. Compared to patients receiving conservative therapy only, patients receiving conservative therapy plus α-blockers were 44% more likely to spontaneously expel the stones (RR 1.44, 95% CI 1.31 to 1.59, p <0.001), and stone expulsion incidence increased significantly (RD 0.28, 95% CI 0.22 to 0.34, p <0.001). Sensitivity and subgroup analyses categorized by specific α-blocker, prior use of shock wave lithotripsy and stone size produced similar effect estimates, but were generally less precise due to smaller sample sizes. The largest subgroup of trials (664 participants) studied tamsulosin without prior shock wave lithotripsy (RR 1.44, 95% CI 1.32 to 1.58; RD 0.29, 95% CI 0.23 to 0.35).Conclusionsα-Blocker therapy is associated with significantly increased rates of distal ureteral stone expulsion.