📃 Paper Title: Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis
🧍 Author: John M Hollingsworth
🕒 Year: 2016
📚 Journal: The BMJ
🌎 Country: USA
ㅤContext to the study:
Can you tell me about a meta-analysis that shows good evidence for the use of alpha blockers in treating ureteric stones?
ㅤ✅ Take-home message of study:
There is moderate evidence that patients treated with alpha blockers have a 49% higher risk of stone passage
Patients with larger stones that are treated with an alpha blocker have a greater chance of stone passage regardless of their location
Patients who received alpha blockers had significantly shorter times to stone passage, fewer episodes of pain, lower risks of surgical intervention, lower risks of admission to hospital.
ㅤ Systematic review and meta-analysis
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Study participants:
55 randomized controlled trials were included, involving 5990 randomized patients
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Key study outcomes:
Alpha blockers may help facilitate passage of ureteric stones (random effects pooled risk ratio 1.49, 95% confidence interval 1.39 to 1.61). Moderate evidence on GRADE approach.
Based on subgroup analysis, there seemed to be no benefit to treatment with alpha blocker among patients with smaller ureteric stones (1.19, 1.00-1.48)
But patients with larger stones treated with an alpha blocker had a 57% higher risk of stone passage compared to controls (1.57, 1.17-2.27). The effect of alpha blockers was independent of location for mid to upper ureteric stones
Meta-regression indicated a 9.8% increase in the risk ratio for stone passage for every 1 mm increase in stone size (2.5% -17.7% p<0.01)
24 studies reported on time to stone passage; treatment with an alpha blocker was associated with an shorter time to stone passage (2862 patients: pooled mean difference −3.79 days)
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Study Limitations:
Significant heterogeneity between pooled studies (inconsistent use of type of alpha blocker, post-treatment imaging, and differential follow-up)
Limited methodological rigor of pooled studies: eg only 6 studies reported blinding of outcomes
Publication bias- smaller studies with negative results may not have been published
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