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Meta-Analysis
. 2015 Nov-Dec;41(6):1049-57.
doi: 10.1590/S1677-5538.IBJU.2015.0048.

The use of alpha-1 adrenergic blockers in children with distal ureterolithiasis: a systematic review and meta-analysis

F P Glina  1 , P M V Castro  1 , G G R Monteiro  1 , G C Del Guerra  1 , Sidney Glina  2 , M Mazzurana  1   3 , W M Bernardo  1   4
Affiliations
Meta-Analysis

The use of alpha-1 adrenergic blockers in children with distal ureterolithiasis: a systematic review and meta-analysis

F P Glina et al. Int Braz J Urol. 2015 Nov-Dec.

Abstract

Introduction: Urinary lithiasis is the main urologic cause of emergency treatment in adult patient. In the past years, the incidence in children population has increased. However, literature about the use of alpha-1 adrenergic blockers in pediatric population with distal ureterolithiasis is still scarce. The drug acts by decreasing ureter contractions, especially in the distal portion, facilitating calculus expulsion.

Objective: This review has the objective to evaluate the use of alpha-1 adrenergic blockers as medical expulsive treatment in children with distal ureterolithiasis.

Evidence acquisition: An electronic literature search was performed using the MEDLINE, COCHRANE, and LILACS databases. We further searched manually the references of the primary studies. Searches were concluded on October 4th, 2014. Articles were selected, independently and in pairs, by the respective titles and summaries. Any divergence was resolved by consensus.

Evidence synthesis: Alpha-1 adrenergic antagonists increased the probability of calculus expulsion by 27% (NNT=4). Calculi smaller than 5mm, increased by 33% (NNT=3). Larger than 5mm, increased by 34% (NNT=3).

Conclusion: Alpha-1 adrenergic blocker use is related with a greater incidence of expulsion of ureteral calculi, smaller or greater than 5mm, and fewer episodes of pain when compared to ibuprofen. However it is necessary larger samples to enhance the power analysis of the expulsion of ureteral calculi larger than 5mm and the episodes of pain.

Patient summary: This review analyzed the outcome of alpha adrenergic antagonist in children with ureteral calculi. We conclude that it is the best medicine for use, since it helps the expulsion of the stone.

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Conflict of interest statement

CONFLICT OF INTEREST

None declared.

Figures

Figure 1
Figure 1. Prisma 2009 Flow Diagram (15).
Figure 2
Figure 2. Meta-analysis of the incidence of ureteral calculus expulsion.
Figure 3
Figure 3. Meta-analysis of the difference in means of pain episodes.
Figure 4
Figure 4. Meta-analysis of the incidence of ureteral calculi expulsion smaller than 5mm.
Figure 5
Figure 5. Funnel-plot of the outcome that presented heterogeneity above than 50%.
Figure 6
Figure 6. Meta-analysis of the incidence of expulsion of ureteral calculi larger than 5mm.
See this image and copyright information in PMC

References

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