Ver el código de «EBQ:Alpha-blockers for ureteral stone expulsion»

==Clinical Question==
Do alpha-blockers expedite ureteral stone passage?

==Pro Argument==
*Current Cochrane Review concludes: "the use of alpha-blockers in adult patients with ureteral stones appears to expedite spontaneous passage, with only minor potential adverse effects."<ref>Welch JL and Cooper DD. Systematic review Snapshot. Annals of Emergency Medicine. January 2016. 67(1):117-118.</ref><ref>Campschroer et al. Alpha-blockers as medical expulsive therapy for ureteral stones. Cochrane Databse Syst Rev. 2014(4):CD008509</ref>
*There is evidence that the subgroup of large distal stones >5mm benefit from tamulosin (passage rate of 83.3% with tamulosin versus 61.0% with placebo)<ref>Furyk, JS, et al. Distal Ureteric Stones and Tamsulosin: A Double-Blind, Placebo-Controlled, Randomized, Multicenter Trial. Annals of Emergency Medicine. 2016; 67(1):86-95.e2.</ref>

===Trial 1===

===Trial 2===

===Trial 3===

==Con Argument==
*Although meta-analyses of previous randomized controlled trials concluded that the smooth muscle relaxant drugs [[tamsulosin]] and [[nifedipine]] assisted stone passage for people managed expectantly for ureteric colic, a randomized placebo-controlled trial demonstrated that no difference was noted between active treatment and placebo (p=0.78), or between tamsulosin and [[nifedipine]] (p=0.77).<ref>Singh A, et al. A systematic review of medical therapy to facilitate the passage of ureteral calculi. Annals of Emerg Med. 2007; 552-563.</ref><ref>Pickard R, et al. Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial. Lancet. 2015; epub.</ref>


===Trial 1===

===Trial 2===

===Trial 3===

==Conclusion==
*Alpha-blockers (tamsulosin) increase spontaneous stone passage rate for distal ureteral stones
*Number needed to treat (NNT) of approximately 4-5 for distal ureteral stones
*Benefit is most pronounced for stones 5-10mm in the distal ureter

==Major Points==
*Medical expulsive therapy (MET) with alpha-blockers facilitates stone passage by relaxing ureteral smooth muscle
*Tamsulosin 0.4mg daily is the most studied alpha-blocker for this indication
*The SUSPEND trial (2015) challenged prior positive meta-analyses, finding no benefit of tamsulosin or nifedipine
*Subsequent meta-analyses including SUSPEND still show overall benefit, primarily for larger distal stones
*Alpha-blockers also appear to reduce pain episodes and analgesic requirements during stone passage

==Study Design==
*Meta-analysis of randomized controlled trials
*Included multiple RCTs comparing alpha-blockers vs placebo or standard care for ureteral stone expulsion

==Population==
===Inclusion Criteria===
*Adults with confirmed ureteral stones (typically <10mm)
*Stones located in the distal ureter in most studies
===Exclusion Criteria===
*Stones requiring urgent intervention (complete obstruction, infection, renal failure)
*Pregnancy
*Stones >10mm in most studies

==Interventions==
*Alpha-blocker therapy (most commonly tamsulosin 0.4mg daily) for 2-4 weeks
*Control: placebo or standard analgesic care without alpha-blockers

==Outcomes==
===Primary Outcome===
*Stone passage rate: alpha-blockers associated with higher spontaneous passage rates (pooled RR approximately 1.4-1.5)
===Secondary Outcomes===
*Reduced time to stone passage
*Reduced analgesic use
*Lower rates of surgical intervention
*Side effects: orthostatic hypotension, dizziness (generally mild)

==Criticisms==
*Significant heterogeneity across included studies in terms of stone size, location, and treatment duration
*Many earlier studies were small and of lower methodological quality
*The SUSPEND trial (largest single RCT) was negative, raising questions about publication bias in earlier meta-analyses
*Benefit appears limited to larger stones (5-10mm) in the distal ureter; unclear benefit for smaller or proximal stones
*Alpha-blockers are used off-label for this indication

==Funding==
*Variable across included trials

==See Also==
*[[Urolithiasis]]

==References==
<references/>

[[Category:EBQ]]