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Meta-Analysis
. 2018 Apr 5;4(4):CD008509.
doi: 10.1002/14651858.CD008509.pub3.

Alpha-blockers as medical expulsive therapy for ureteral stones

Thijs Campschroer  1 , Xiaoye Zhu, Robin Wm Vernooij, Mtw Tycho Lock
Affiliations
Meta-Analysis

Alpha-blockers as medical expulsive therapy for ureteral stones

Thijs Campschroer et al. Cochrane Database Syst Rev. .

Abstract

Background: Ureteral colic is a common reason for patients to seek medical care. Alpha-blockers are commonly used to improve stone passage through so-called medical expulsive therapy (MET), but their effectiveness remains controversial. This is an update of a 2014 Cochrane review; since that time, several large randomised controlled trials (RCTs) have been reported, making this update relevant.

Objectives: To assess effects of alpha-blockers compared with standard therapy for ureteral stones 1 cm or smaller confirmed by imaging in adult patients presenting with symptoms of ureteral stone disease.

Search methods: On 18 November 2017, we searched CENTRAL, MEDLINE Ovid, and Embase. We also searched ClinicalTrials.gov and the WHO Portal/ICTRP to identify all published/unpublished and ongoing trials. We checked all references of included and review articles and conference proceedings for articles relevant to this review. We sent letters to investigators to request information about unpublished or incomplete studies.

Selection criteria: We included RCTs of ureteral stone passage in adult patients that compared alpha-blockers versus standard therapy.

Data collection and analysis: Two review authors screened studies for inclusion and extracted data using standard methodological procedures. We performed meta-analysis using a random-effects model. Primary outcomes were stone clearance and major adverse events; secondary outcomes were stone expulsion time, number of pain episodes, use of diclofenac, hospitalisation, and surgical intervention. We assessed the quality of evidence on a per-outcome basis using the GRADE approach.

Main results: We included 67 studies with 10,509 participants overall. Of these, 15 studies with 5787 participants used a placebo.Stone clearance: Based on the overall analysis, treatment with an alpha-blocker may result in a large increase in stone clearance (risk ratio (RR) 1.45, 95% confidence interval (CI) 1.36 to 1.55; low-quality evidence). A subset of higher-quality, placebo-controlled trials suggest that the likely effect is probably smaller (RR 1.16, 95% CI 1.07 to 1.25; moderate-quality evidence), corresponding to 116 more (95% CI 51 more to 182 more) stone clearances per 1000 participants.Major adverse events: Based on the overall analysis, treatment with an alpha-blocker may have little effect on major adverse events (RR 1.25, 95% CI 0.80 to 1.96; low-quality evidence). A subset of higher-quality, placebo-controlled trials suggest that alpha-blockers likely increase the risk of major adverse events slightly (RR 2.09, 95% CI 1.13 to 3.86), corresponding to 29 more (95% CI 3 more to 75 more) major adverse events per 1000 participants.Patients treated with alpha-blockers may experience shorter stone expulsion times (mean difference (MD) -3.40 days, 95% CI -4.17 to -2.63; low-quality evidence), may use less diclofenac (MD -82.41, 95% CI -122.51 to -42.31; low-quality evidence), and likely require fewer hospitalisations (RR 0.51, 95% CI 0.34 to 0.77; moderate-quality evidence), corresponding to 69 fewer hospitalisations (95% CI 93 fewer to 32 fewer) per 1000 participants. Meanwhile, the need for surgical intervention appears similar (RR 0.74, 95% CI 0.53 to 1.02; low-quality evidence), corresponding to 28 fewer surgical interventions (95% CI 51 fewer to 2 more) per 1000 participants.A predefined subgroup analysis (test for subgroup differences; P = 0.002) suggests that effects of alpha-blockers may vary with stone size, with RR of 1.06 (95% CI 0.98 to 1.15; P = 0.16; I² = 62%) for stones 5 mm or smaller versus 1.45 (95% CI 1.22 to 1.72; P < 0.0001; I² = 59%) for stones larger than 5 mm. We found no evidence suggesting possible subgroup effects based on stone location or alpha-blocker type.

Authors' conclusions: For patients with ureteral stones, alpha-blockers likely increase stone clearance but probably also slightly increase the risk of major adverse events. Subgroup analyses suggest that alpha-blockers may be less effective for smaller (5 mm or smaller) than for larger stones (greater than 5 mm).

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Conflict of interest statement

Thijs Campschroer: none. Xiaoye Zhu: none. Robin WM Vernooij: none. MTW Tycho Lock: none.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Funnel plot of comparison: 1 Alpha‐blocker versus standard therapy or placebo, outcome: 1.1 Stone clearance.
5
5
Funnel plot of comparison: 1 Alpha‐blocker versus standard therapy or placebo, outcome: 1.2 Major adverse events.
6
6
Funnel plot of comparison 2: Alpha‐blocker versus placebo, outcome: 2.2 Major adverse events.
1.1
1.1. Analysis
Comparison 1 Alpha‐blocker versus standard therapy or placebo, Outcome 1 Stone clearance.
1.2
1.2. Analysis
Comparison 1 Alpha‐blocker versus standard therapy or placebo, Outcome 2 Major adverse events.
1.3
1.3. Analysis
Comparison 1 Alpha‐blocker versus standard therapy or placebo, Outcome 3 Stone expulsion time.
1.4
1.4. Analysis
Comparison 1 Alpha‐blocker versus standard therapy or placebo, Outcome 4 Pain episodes.
1.5
1.5. Analysis
Comparison 1 Alpha‐blocker versus standard therapy or placebo, Outcome 5 Dose of diclofenac.
1.6
1.6. Analysis
Comparison 1 Alpha‐blocker versus standard therapy or placebo, Outcome 6 Hospitalisation.
1.7
1.7. Analysis
Comparison 1 Alpha‐blocker versus standard therapy or placebo, Outcome 7 Surgical intervention.
2.1
2.1. Analysis
Comparison 2 Subgroup analysis 1: stones measuring 5 mm or less versus stones measuring 6 to 10 mm, Outcome 1 Stone clearance.
2.2
2.2. Analysis
Comparison 2 Subgroup analysis 1: stones measuring 5 mm or less versus stones measuring 6 to 10 mm, Outcome 2 Stone expulsion time.
3.1
3.1. Analysis
Comparison 3 Subgroup analysis 2: distal ureter versus mid or proximal ureter stones, Outcome 1 Stone clearance.
3.2
3.2. Analysis
Comparison 3 Subgroup analysis 2: distal ureter versus mid or proximal ureter stones, Outcome 2 Stone expulsion time.
4.1
4.1. Analysis
Comparison 4 Subgroup analysis 3: type of alpha‐blocker, Outcome 1 Stone clearance.
4.2
4.2. Analysis
Comparison 4 Subgroup analysis 3: type of alpha‐blocker, Outcome 2 Major adverse events.
4.3
4.3. Analysis
Comparison 4 Subgroup analysis 3: type of alpha‐blocker, Outcome 3 Stone expulsion time.
4.4
4.4. Analysis
Comparison 4 Subgroup analysis 3: type of alpha‐blocker, Outcome 4 Pain episodes.
4.5
4.5. Analysis
Comparison 4 Subgroup analysis 3: type of alpha‐blocker, Outcome 5 Dose of diclofenac [mg].
4.6
4.6. Analysis
Comparison 4 Subgroup analysis 3: type of alpha‐blocker, Outcome 6 Hospitalisation.
4.7
4.7. Analysis
Comparison 4 Subgroup analysis 3: type of alpha‐blocker, Outcome 7 Surgical intervention.
5.1
5.1. Analysis
Comparison 5 Sensitivity analysis 1: alpha‐blocker versus placebo, Outcome 1 Stone clearance.
5.2
5.2. Analysis
Comparison 5 Sensitivity analysis 1: alpha‐blocker versus placebo, Outcome 2 Major adverse events.
5.3
5.3. Analysis
Comparison 5 Sensitivity analysis 1: alpha‐blocker versus placebo, Outcome 3 Stone expulsion time.
5.4
5.4. Analysis
Comparison 5 Sensitivity analysis 1: alpha‐blocker versus placebo, Outcome 4 Pain episodes.
5.5
5.5. Analysis
Comparison 5 Sensitivity analysis 1: alpha‐blocker versus placebo, Outcome 5 Dose of diclofenac.
5.6
5.6. Analysis
Comparison 5 Sensitivity analysis 1: alpha‐blocker versus placebo, Outcome 6 Hospitalisation.
5.7
5.7. Analysis
Comparison 5 Sensitivity analysis 1: alpha‐blocker versus placebo, Outcome 7 Surgical intervention.
6.1
6.1. Analysis
Comparison 6 Sensitivity analysis 2: high‐quality studies, Outcome 1 Stone clearance.
6.2
6.2. Analysis
Comparison 6 Sensitivity analysis 2: high‐quality studies, Outcome 2 Major adverse events.
6.3
6.3. Analysis
Comparison 6 Sensitivity analysis 2: high‐quality studies, Outcome 3 Stone expulsion time.
6.4
6.4. Analysis
Comparison 6 Sensitivity analysis 2: high‐quality studies, Outcome 4 Pain episodes.
6.5
6.5. Analysis
Comparison 6 Sensitivity analysis 2: high‐quality studies, Outcome 5 Dose of diclofenac.
6.6
6.6. Analysis
Comparison 6 Sensitivity analysis 2: high‐quality studies, Outcome 6 Hospitalisation.
6.7
6.7. Analysis
Comparison 6 Sensitivity analysis 2: high‐quality studies, Outcome 7 Surgical intervention.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Abdel‐Meguid 2010 {published data only}
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Ahmad 2015 {published data only}
    1. Ahmad H, Azim W, Akmal M, Murtaza B, Mahmood A, Nadim A, et al. Medical expulsive treatment of distal ureteral stone using tamsulosin. Journal of Ayub Medical College Abbottabad 2015;27(1):48‐50. - PubMed
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Berger 2015 {published data only}
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Cha 2012 {published data only}
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Cho 2017 {published data only}
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Doluoglu 2015 {published data only}
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El‐Gamal 2012 {published data only}
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El Said 2015 {published data only}
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Erkan 2011 {published data only}
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Erturhan 2007 {published data only}
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Eryildirim 2015 {published data only}
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Ferre 2009 {published data only}
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Furyk 2016 {published data only}
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Georgescu 2015 {published data only}
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Griwan 2010 {published data only}
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Han 2006a {published data only}
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Hermanns 2009 {published data only}
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Hong 2008 {published data only}
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Ibrahim 2013 {published data only}
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Islam 2010 {published data only}
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Itoh 2011 {published data only}
    1. Itoh Y, Okada A, Yasui T, Taguchi K, Niimi K, Fujii Y, et al. Efficacy of a selective alpha 1A adrenoceptor antagonist silodosin in the medical expulsive therapy for ureteral stones. International Journal of Urology 2011;18:672‐4. [MEDLINE: ] - PubMed
Itoh 2013 {published data only}
    1. Itoh Y, Okada A, Taguchi K, Hirose Y, Fujii Y, Kobayashi T, et al. Administration of the selective alpha 1A adrenoceptor antagonist silodosin facilitates expulsion of size 5‐10 mm distal ureteral stones, as compared to control. Journal of Urology (Suppl) 2015;193(4S):e502. - PubMed
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Kaneko 2010 {published data only}
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Kim 2007b {published data only}
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Kupeli 2004 {published data only}
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Lee 2014 {published data only}
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Liatsikos 2007 {published data only}
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Lojanapiwat 2008 {published data only}
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Lojanapiwat 2012 {published data only}
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Maitra 2012 {published data only}
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Meltzer 2017 {published data only}
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Mshemish 2012 {published data only}
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Mukhtarov 2007 {published data only}
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Ochoa‐Gomez 2011 {published data only}
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Park 2012 {published data only}
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Pedro 2008 {published data only}
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Pickard 2015 {published data only}
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Porpiglia 2006 {published data only}
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Porpiglia 2009 {published data only}
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Rahim 2012 {published data only}
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Sayed 2008 {published data only}
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Sen 2017 {published data only}
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Sun 2009 {published data only}
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Sur 2015 {published data only}
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Taghavi 2005 {published data only}
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Vincendeau 2010 {published data only}
    1. Vincendeau S, Bellissant E, Bensalah K, Houlgatte A, Dore B, Bruyere F, et al. Lack of efficacy of tamsulosin in the treatment of distal ureteral stones [abstract no: 1491]. Journal of Urology 2008;179(4 Suppl 1):508.
    1. Vincendeau S, Bellissant E, Bensalah K, Houlgatte A, Dore B, Bruyere F, et al. Lack of efficacy of tamsulosin in the treatment of distal ureteral stones [abstract no: 313]. European Urology Supplements 2008;7(3):149. [CN‐00794344]
    1. Vincendeau S, Bellissant E, Houlgatte A, Dore B, Bruyere F, Renault A, et al. Tamsulosin hydrochloride vs placebo for management of distal ureteral stones: a multicentric, randomized, double‐blind trial. Archives of Internal Medicine 2010;170(22):2021‐7. [MEDLINE: ] - PubMed
Wang 2008a {published data only}
    1. Wang CJ, Huang SW, Chang CH. Efficacy of an alpha1 blocker in expulsive therapy of lower ureteral stones. Journal of Endourology 2008;22(1):41‐6. [MEDLINE: ] - PubMed
Ye 2017 {published data only}
    1. Ye Z, Zeng G, Yang H, Tang K, Zhang X, Li H, et al. Efficacy and safety of tamsulosin in medical expulsive therapy for distal ureteral stones with renal colic: a multicenter, randomized, double‐blind, placebo‐controlled trial. European Urology 12 Nov 2017;Epub ahead of print(3):385‐91. [MEDLINE: ] - PubMed
Yencilek 2010 {published data only}
    1. Yencilek F, Erturhan S, Canguven O, Koyuncu H, Erol B, Sarica K. Does tamsulosin change the management of proximally located ureteral stones?. Urological Research 2010;38(3):195‐9. [MEDLINE: ] - PubMed
Yilmaz 2005 {published data only}
    1. Yilmaz E, Batislam E, Basar MM, Tuglu D, Ferhat M, Basar H. The comparison and efficacy of 3 different alpha1‐adrenergic blockers for distal ureteral stones. Journal of Urology 2005;173(6):2010‐2. [MEDLINE: ] - PubMed
Yuksel 2015 {published data only}
    1. Yuksel M, Yilmaz S, Tokgoz H, Yalcinkaya S, Bas S, Ipekci T, et al. Efficacy of silodosin in the treatment of distal ureteral stones 4 to 10 mm in diameter. International Journal of Clinical and Experimental Medicine 2015;8(10):19086‐92. - PMC - PubMed
Zehri 2010 {published data only}
    1. Zehri AA, Ather MH, Abbas F, Biyabani SR. Preliminary study of efficacy of doxazosin as a medical expulsive therapy of distal ureteric stones in a randomized clinical trial. Urology 2010;75(6):1285‐8. [MEDLINE: ] - PubMed
Zhou 2011 {published data only}
    1. Zhou SG, Lu JL, Hui JH. Comparing efficacy of a1D‐receptor antagonist naftopidil and a1A/D‐receptor antagonist tamsulosin in management of distal ureteral stones. World Journal of Urology 2011;29:767‐71. [MEDLINE: ] - PubMed

References to studies excluded from this review

Agarwal 2009 {published data only}
    1. Agarwal MM, Naja V, Singh SK, Mavuduru R, Mete UK, Kumar S, et al. Is there an adjunctive role of tamsulosin to extracorporeal shockwave lithotripsy for upper ureteric stones: results of an open label randomized nonplacebo controlled study. Urology 2009;74(5):989‐92. [MEDLINE: ] - PubMed
Aravinthan 2012 {published data only}
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Avdoshin 2005 {published data only}
    1. Avdoshin VP, Andriukhin MI, Barabash MI, Taskinen I, Ol'shanskaia EV, Motin PI, et al. Tamsulosin in the treatment of patients with ureteroliths of the lower third of the ureter clinical and pharmacoeconomic grounds. Urologiia (Moscow, Russia) 2005, (4):36‐9. [MEDLINE: ] - PubMed
Aydogdu 2009 {published data only}
    1. Aydogdu O, Burgu B, Gucuk A, Suer E, Soygur T. Effectiveness of doxazosin in treatment of distal ureteral stones in children. Journal of Urology 2009;182(6):2880‐4. [MEDLINE: ] - PubMed
Bak 2007 {published data only}
    1. Bak CW, Yoon SJ, Chung H. Effects of an alpha‐blocker and terpene mixture for pain control and spontaneous expulsion of ureter stone. Korean Journal of Urology 2007;48:517‐21.
Bhat 2015 {published data only}
    1. Bhat SK, Bhushan R, Chakarbarty N. Role of alfuzosin in spontaneous passage of distal ureteric calculi. Journal of Medical Science and Clinical Research 2015;3(11):8157‐60.
Borghi 1994 {published data only}
    1. Borghi L, Meschi T, Amato F, Novarini A, Giannini A, Quarantelli C, et al. Nifedipine and methylprednisolone in facilitating ureteral stone passage: a randomized, double‐blind, placebo‐controlled study. Journal of Urology 1994;152(4):1095‐8. [MEDLINE: ] - PubMed
Brausi 2015 {published data only}
    1. Brausi M, Peracchia G, Luca G, Viola M, Giliberto GL. The efficacy of tamsulosin (tams) alone vs corticosteroids alone vs tamsulosin + corticosteroids in determining the spontaneous passage of distal ureteral stones: results of a prospective study. European Urology Supplements 2015;14(2):e389.
Chau 2011 {published data only}
    1. Chau LH, Tai DC, Fung BT, Li JC, Fan CW, Li MK. Medical expulsive therapy using alfuzosin for patient presenting with ureteral stone less than 10mm: a prospective randomized controlled trial. International Journal of Urology 2011;18(7):510‐4. [MEDLINE: ] - PubMed
Cooper 2000 {published data only}
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Cuni 2013 {published data only}
    1. Cuni Xh, Haxhiu I, Xhani M, Cuni H, Haxhiu A, Frangu B, et al. The efficacy of Rowatinex and tamsulosin in patients with selected ureteral stones: a controlled study. European Urology Supplements 2013;12:e1330.
Damiano 2008 {published data only}
    1. Damiano R, Autorino R, Sio M, Giacobbe A, Palumbo IM, D'Armiento M. Effect of tamsulosin in preventing ureteral stent‐related morbidity: a prospective study. Journal of Endourology 2008;22(4):651‐6. [MEDLINE: ] - PubMed
Deliveliotis 2006 {published data only}
    1. Deliveliotis C, Chrisofos M, Gougousis E, Papatsoris A, Dellis A, Varkarakis IM. Is there a role for alpha1‐blockers in treating double‐J stent‐related symptoms?. Urology 2006;67(1):35‐9. [MEDLINE: ] - PubMed
Dellabella 2003 {published data only}
    1. Dellabella M, Milanese G, Muzzonigro G. Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. Journal of Urology 2003;170(6 Pt 1):2202‐5. [MEDLINE: ] - PubMed
Dellabella 2005 {published data only}
    1. Dellabella M, Milanese G, Muzzonigro G. Randomized trial of the efficacy of tamsulosin, nifedipine and phloroglucinol in medical expulsive therapy for distal ureteral calculi. Journal of Urology 2005;174(1):167‐72. [MEDLINE: ] - PubMed
Dellabella 2005a {published data only}
    1. Dellabella M, Milanese G, Muzzonigro G. Medical‐expulsive therapy for distal ureterolithiasis: randomized prospective study on role of corticosteroids used in combination with tamsulosin‐simplified treatment regimen and health‐related quality of life. Urology 2005;66(4):712‐5. [MEDLINE: ] - PubMed
Gandhi 2013 {published data only}
    1. Gandhi HR, Agrawal C. The efficacy of tamsulosin vs. nifedipine for the medical expulsive therapy of distal ureteric stones: a randomised clinical trial. Arab Journal of Urology 2013;11:405‐10. [MEDLINE: ] - PMC - PubMed
Gupta 2013 {published data only}
    1. Gupta S, Lodh B, Singh AK, Somarendra K, Meitei KS, Singh SR. Comparing the efficacy of tamsulosin and silodosin in the medical expulsion therapy for ureteral calculi. Journal of Clinical and Diagnostic Research 2013;7(8):1672‐4. - PMC - PubMed
Gupta Shyam 2014 {published data only}
    1. Shyam KG, Vishal K, Geetanjali G, Ankush B, Anjali S. Clinical evaluation of 'suspend' trial with herbal preparation and tamsulosin: a medical expulsive therapy for urolithiasis. International Research Journal of Pharmacy 2014;5(12):915‐7.
Gurbuz 2011 {published data only}
    1. Gurbuz MC, Polat H, Canat L, Kilic M, Caskurlu T. Efficacy of three different alpha 1‐adrenergic blockers and hyoscine N‐butylbromide for distal ureteral stones. International Brazilian Journal of Urology 2011;37(2):195‐202. - PubMed
Haxhiu 2014 {published data only}
    1. Haxhiu I, Quni X, Haxhiu A, Arifi H, Haxhiu E, Ahmeti H, et al. Our experience in the treatment of urolithiasis with tamsulosin. Urolithiasis 2014;42:490‐1.
Hwang 2012 {published data only}
    1. Hwang EC, Hwang IS, Yu HS, Kim S‐O, Jung SI, Kang TW, et al. Effects of alfuzosin with methylprednisolone for spontaneous expulsion and pain control of lower ureteral stone. Urological Research 2012;40:605‐9. - PubMed
Imperatore 2014 {published data only}
    1. Imperatore V, Fusco F, Creta M, Meo S, Buonopane R, Longo N, et al. Medical expulsive therapy for distal ureteric stones: tamsulosin versus silodosin. Archivio Italiano di Urologia e Andrologia 2014;86(2):103‐7. - PubMed
ISRCTN24675122 {published data only}
    1. Davenport K. A randomised control trial comparing spontaneous ureteric stone passage rates with tamsulosin versus placebo in the management of acute renal colic. http://www.controlled‐trials.com [accessed on 18 November 2017] 2003.
Itano 2012 {published data only}
    1. Itano N, Ferlic E, Nunez‐Nateras R, Humphreys MR. Medical expulsive therapy in a tertiary care emergency department. Urology 2012;79:1242‐6. [MEDLINE: ] - PubMed
Jayant 2014 {published data only}
    1. Jayant K, Agrawal R, Agrawal S. Tamsulosin versus tamsulosin plus tadalafil as medical expulsive therapy for lower ureteric stones: a randomized controlled trial. International Journal of Urology 2014;21:1012‐5. - PubMed
John 2010 {published data only}
    1. John TT, Razdan S. Adjunctive tamsulosin improves stone free rate after ureteroscopic lithotripsy of large renal and ureteric calculi: a prospective randomized study. Urology 2010;75(5):1040‐2. [MEDLINE: ] - PubMed
    1. John TT, Razdan S. Adjunctive tamsulosin improves stone free rate after ureteroscopic lithotripsy of large renal and ureteric calculi: a prospective randomized study [abstract no: 1460]. Journal of Urology 2008;179(4 Suppl 1):498. - PubMed
Khawaja 2005 {published data only}
    1. Khawaja AA, Ahmed R, Anjum R, Zaidi AI. Role of alpha blockers in the management of lower ureteric stones. Medical Forum Monthly 2005;16(1):7‐11. [EMBASE: 2007147954]
Kumar 2014 {published data only}
    1. Kumar S, Kurdia KC, Ganesamoni R, Singh SK, Nanjappa B. Randomized controlled trial to compare the safety and efficacy of naftopidil and tamsulosin as medical expulsive therapy in combination with prednisolone for distal ureteral stones. Korean Journal of Urology 2014;54:311‐5. - PMC - PubMed
Kumar 2015 {published data only}
    1. Kumar S, Jayant K, Agrawal MM, Singh SK, Agrawal S, Parmar KM. Role of tamsulosin, tadalafil, and silodosin as the medical expulsive therapy in lower ureteric stone: a randomized trial (a pilot study). Urology 2015;85:59‐63. - PubMed
Loftus 2015 {published data only}
    1. Loftus C, Nyame Y, Hinck B, Greene D, Chaparala H, Alazem K, et al. Medical expulsive therapy is underused for the management of renal colic in the emergency setting. Journal of Urology 2015;E‐pub, ahead of print(doi: 10.1016/j.juro.2015.11.026):987–91. [MEDLINE: ] - PubMed
Lu 2012 {published data only}
    1. Lu JL, Tang QL, Liu F, Hui JH. Naftopidil and tolterodine in the medical expulsive therapy for intramural ureteral stones: a prospective randomized study. Urological Research 2012;40:757‐62. [MEDLINE: ] - PubMed
Mohseni 2006 {published data only}
    1. Mohseni MG, Hosseini SR, Alizadeh F. Efficacy of terazosin as a facilitator agent for expulsion of the lower ureteral stones. Saudi Medical Journal 2006;27(6):838‐40. [MEDLINE: ] - PubMed
Moon 2015 {published data only}
    1. Moon YJ, Kim HW, Kim JB, Kim HJ, Chang YS. Distribution of ureteral stones and factors affecting their location and expulsion in patients with renal colic. Korean Journal of Urology 2015;56(10):717‐21. [MEDLINE: ] - PMC - PubMed
Morozumi 2013 {published data only}
    1. Morozumi M, Ishii N, Cho E, Sakaguchi K, Yano A, Okada Y, et al. Effects of naftopidil or butylscopolamine for the ureteral stone events. European Urology Supplements 2013;12:58‐9.
Multescu 2014 {published data only}
    1. Multescu R, Georgescu D, Satalan R, Geavlete B, Geavlete P. Conservative treatment in patients with ureteral stones and renal colic. Urology 2014;84(4 Suppl 1):UP575, unmoderated poster session.
Nasim 2014 {published data only}
    1. Nasim I, Ather H. Predictors for spontaneous stone passage in patients with ureteral calculi at emergency department. Urolithiasis 2014;42:475‐508.
Ohgaki 2010 {published data only}
    1. Ohgaki K, Horiuchi K, Hikima N, Kondo Y. Facilitation of expulsion of ureteral stones by addition of alpha1‐blockers to conservative therapy. Scandinavian Journal of Urology and Nephrology 2010;44(6):420‐4. [MEDLINE: ] - PubMed
Porpiglia 2000 {published data only}
    1. Porpiglia F, Destefanis P, Fiori C, Fontana D. Effectiveness of nifedipine and deflazacort in the management of distal ureter stones. Urology 2000;56(4):579‐82. [MEDLINE: ] - PubMed
Ramesh 2015 {published data only}
    1. Ramesh O, Rani BS, Prabhu GR. Medical expulsive therapy of ureteric calculi ‐ our experience. Journal of Evidence Based Medicine and Healthcare 2015;2(40):6612‐8. [DOI: 10.18410/jebmh/2015/902] - DOI
Reddy 2016 {published data only}
    1. Reddy RK, Reddy SA. The efficacy of alpha‐blockers for expulsion of distal ureteral stones. International Surgery Journal 2016;3(1):336‐40. [DOI: ]
Resim 2005 {published data only}
    1. Resim S, Ekerbicer H, Ciftci A. Effect of tamsulosin on the number and intensity of ureteral colic in patients with lower ureteral calculus. International Journal of Urology 2005;12(7):615‐20. [MEDLINE: ] - PubMed
Resorlu 2011 {published data only}
    1. Resorlu B, Bozkurt OF, Senocak C, Unsal A. Effectiveness of doxazosin in the management of lower ureteral stones in male and female patients. International Urology and Nephrology 2011;43:645‐9. [DOI: 10.1007/s11255-010-9867-8] - DOI - PubMed
Salem 2015 {published data only}
    1. Salem EAH, Kamel M, Sakr AMN, Fawzy A, Shahin A. Silodosin versus tamsulosin in the management of distal ureteric stones. European Urology Supplements 2015;14(2):e387. - PMC - PubMed
Sameer 2014 {published data only}
    1. Sameer, Lal S, Charak KS, Chakravarti S, Kohli S, Ahmad S. Efficacy of nifedipine and alfuzosin in the management of distal ureteric stones: a randomized, controlled study. Indian Journal of Urology 2014;30(4):387‐91. - PMC - PubMed
Shabana 2015 {published data only}
    1. Shabana W, Teleb M, Dawod T, Eladl M. A prospective randomized study to evaluate the outcome of alpha blockers and the combination with methylprednisolone in medical expulsive therapy for lower ureteral stones. Journal of Urology 2015;193(4S):e503. - PMC - PubMed
Shah 2013 {published data only}
    1. Shah YD, Thekdi PI, Patel KG. Medical expulsive therapy for the management of ureteric calculi. International Journal of Research in Medical Sciences 2013;1(3):267‐70. [DOI: 10.5455/2320-6012.ijrms20130821] - DOI
Skrekas 2003 {published data only}
    1. Skrekas T, Liapis D, Kalantzis A, Argyropoulos A, Doumas K, Lycourinas M. Increasing the success rate of medical therapy for expulsion of distal ureteral stones using adjunctive treatment with calcium channel blocker [abstract no: 317]. European Urology Supplements 2003;2(1):82. [CENTRAL: CN‐00653802]
Su 2016 {published data only}
    1. Su YC, Wang CJ, Chang CH, Chen HW, Tsai PC. Efficacy of a highly selective α‐1 adrenoceptor antagonist in expulsive therapy of distal ureteral stones: a randomized controlled study. Academia Journal of Biotechnology 2016;4(6):241‐6. [DOI: 10.15413/ajb.2016.0103] - DOI
Sumer 2012 {published data only}
    1. Sumer A, Kaynar M, Topbas E, Hassan MA, Gurbuz R. Comparison of the therapeutic effects of diclofenac sodium,prednisolone and an alpha blocker for the treatment of renal colic [Akut renal kolik tedavisinde diklofenak sodyum, metilprednizolon ve alfa blokörtedavilerinin karşılaştırılması]. Turkish Journal of Urology 2012;38(1):23‐8. [DOI: 10.5152/tud.2012.005] - DOI
Tchey 2011 {published data only}
    1. Tchey DU, Ha YS, Kim WT, Yun SJ, Lee SC, Kim WJ. Expectant management of ureter stones: outcome and clinical factors of spontaneous passage in a single institution's experience. Korean Journal of Urology 2011;52(12):847‐51. [MEDLINE: ] - PMC - PubMed
Tsuzaka 2011 {published data only}
    1. Tsuzaka Y, Matsushima H, Kaneko T, Yamaguchi T, Homma Y. Naftopidil vs silodosin in medical expulsive therapy for ureteral stones: a randomized controlled study in Japanese male patients. International Journal of Urology 2011;18:792‐5. - PubMed
Vavassori 2012 {published data only}
    1. Vavassori I, Giliberto GL, Cau L, Brausi M, Vecchia S. The comparison between efficacy of tamsulosin alone or in combination with corticosteroids vs corticosteroids alone vs analgesics in spontaneous passage of distal ureteral stones: results of a prospective study. Journal of Endourology 2012;26(Suppl 1):178.
Wang 2009c {published data only}
    1. Wang CJ, Huang SW, Chang CH. Adjunctive medical therapy with an alpha‐1A‐specific blocker after shock wave lithotripsy of lower ureteral stones. Urologia Internationalis 2009;82(2):166‐9. [MEDLINE: ] - PubMed

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References to other published versions of this review

Campschroer 2014
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