📃 Paper Title: a-blockers as medical expulsive therapy for ureteric stones: a Cochrane systematic review
🧍 Author: Campschroer
🕒 Year: 2018
📚 Journal: BJUI
🌎 Country: Netherlands
ㅤContext to the study:
Can you tell me a paper which supports the use of a-blockers for ureteric stones?
ㅤ✅ Take-home message of study:
In patients with ureteric stones, a-blockers likely increase stone clearance but probably also slightly increase the risk of major adverse events.
Subgroup analyses suggest that a-blockers may be less effective in smaller (≤5 mm) than larger stones (>5 mm).
ㅤ Systematic review and meta-analysis
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Study participants:
67 RCTs, with 10 509 participants overall. Of these, 15 studies with 5 787 participants used a placebo.
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Key study outcomes:
a-blocker associated with a large increase in stone clearance (risk ratio [RR] 1.45, 95% confidence interval [CI] 1.36-1.55; low-quality evidence)
This corresponds to 278 more (95% CI: 223-340 more) stone clearances per 1000 participants.
A-blockers had five more (95% CI four fewer to 19 more) major adverse events per 1 000 participants
The need for surgical intervention appears similar regardless of a-blocker usage (RR 0.74, 95% CI: 0.53-1.02; low-quality evidence).
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Study Limitations:
The quality of evidence was generally low due to inconsistency, imprecision, and risk of bias.
Overall a meta-analysis of low-quality evidence should be interpreted with caution against high-quality well-performed RCTs (e.g. SUSPEND)
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