Clinical Health Updates

Alpha-blocker or nifedipine may help pass kidney stones

Clinical Question:
Can drug treatment improve passage of ureteral stones?

Bottom Line:
This meta-analysis of low-quality studies shows that ureteral stone passage can be enhanced by treating patients with an alpha-blocker such as tamsulosin (Flomax) or the calcium channel blocker nifedipine (Procardia). Better studies may refute these findings, but for now either approach is an option.

Singh A, Alter HJ, Littlepage A. A systematic review of medical therapy to facilitate passage of ureteral calculi. Ann Emerg Med 2007;50(5):552-563.

Study Design:
Meta-analysis (randomized controlled trials)

The researchers conducting this study combined the results of small studies evaluating the effectiveness of alpha-blockers, a calcium channel blocker, or both, to increase the passage of ureteral calculi. The meta-analysis was well done. Two authors independently searched several databases, including the Cochrane database, to find randomized studies. They also conducted a hand search of urologic journals and conference proceedings. Two authors also independently abstracted data. They identified 22 studies. Only 1 study was considered to be of good quality with a Jadad score of 3 (out of a possible 5), with all the rest scoring 1 or 2. All but 1 of the studies was unblinded, and the researchers did not report on whether allocation was concealed in the studies. There was mild heterogeneity found among the alpha-blocker studies, as well as evidence of publication bias. Alpha-blockers, primarily tamsulosin, were studied in 16 trials enrolling 1235 men. Nine trials evaluated the time to stone expulsion in patients with stones of 3 mm to 18 mm in size and located in the distal portion of the ureter, with a 2-day to 6-day average improvement in time to stone passage. The calcium channel blocker was studied in 9 trials of 686 patients with an average stone size of greater than 5 mm located in all aspects of the ureter. The average reduction in time to stone expulsion was not reported, though stone passage was more likely, on average, with treatment (relative risk = 1.50; 95% CI, 1.34-1.68) over the various periods of follow-up.