Alpha blockers for treatment of ureteric stones: systematic review and meta-analysisBMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6112 (Published 01 December 2016) Cite this as: BMJ 2016;355:i6112
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It is good to read this research article “Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis” . The use of alpha blockers is the off-label treatment of medical expulsive therapy (MET) for patients with ureteric stones. Adrenoceptors (AR) subtypes alpha-1A, -1B and -1D are well localized in human ureter, and the expression of subtypes is according to the level of the ureter . According to the Cochrane Database of Systematic Reviews, alpha blockers should be considered as first-line treatment of MET,  and there is high level evidence in the management of patients with ureteric stones .
However, alpha blockers failed to show any benefit and should no longer be used for ureteric stones , and they are unlikely to be cost-effective. Also high-quality trials showed smaller effect size than meta-analysis of lower-quality studies in a report from the SUSPEND trial . Studies revealed that medical expulsive therapy with tamsulosin 400 μg and nifedipine 30 mg were not effective in adults patients with ureteric colic .
Alpha blockers benefit patients with larger ureteric stones, and they reduce the need for surgical interventions and are preferred in hypertensive patients with benign hypertrophy of the prostate; adverse effects associated with the use of alpha blockers may cause problems.
Dr Rajiv Kumar
Faculty, Dept. of Pharmacology,
Government Medical College & Hospital Chandigarh, India.
1 BMJ 2016;355:i6112
3 DOI: 10.1002/14651858.CD008509.pub2 .
4 DOI: http://dx.doi.org/10.1016/j.cct.2016.11.010
5 DOI: http://dx.doi.org/10.1016/j.ijsu.2016.11.006
7 DOI: http://dx.doi.org/10.1016/S0140-6736(15)60933-3
Competing interests: No competing interests