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

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.

The Evidence Paradox of the Effectiveness between the Paediatric and Adult Stone-Forming Population: A Narrative Review

“…In more detail, 11 articles actually dealt with the effects of α-blockers on ureteric stones in the paediatric population. Two meta-analyses of randomized studies were identified (level of evidence, LE: 1a) [6,7], 4 prospective randomized studies (LE: 1b) [8][9][10][11], one well-designed cohort study (LE: 2b) [12], one systematic literature review (LE: 3) [4] and 3 expert panel reports (LE: 4) [13][14][15]. Three articles that discussed the metabolic evaluation and medical treatment of paediatric nephrolithiasis were identified and they consisted 2 welldesigned cohort studies (LE: 2b) [16,17] and one expert panel report (LE: 4) [18].…”

“…The studies were published consecutively and have its origin from different investigator/institutional groups and maintain high methodological standards. In the first study by Glina et al [7], 3 randomized controlled studies up to October 2014 are included and it is concluded that the use of α-1 adrenergic antagonists increases the overall probability of stone expulsion by 27%, with refined odds rising to 33% for calculi <5 mm and 34% >5 mm (LE: 1a). The second metaanalysis by Velázquez et al [6] includes the aforementioned controlled trials as well as 2 retrospective cohorts for data pooling.…”

“…Velázquez et al [6] commented that side effects of MET were minimal, with only few patients complaining of somnolence during treatment. In the systematic review by Glina et al [7], there is no mention of side-effects analysis. When examining the prospective series individually, no adverse effects were reported, other than somnolence, nausea and vomiting experienced by one patient in the study conducted by Erturhan et al [10] and 3 patients experiencing mild nasal congestion in the study by Aldaqadossi et al [11].…”

Question 1: Are alpha-antagonists useful in promoting the passage of renal stones in children?

“…The papers included in these reviews limit their participants to those with stones <12 mm, with most having a <10 mm criteria. Glina et al 2 compared stones smaller and larger than 5 mm and report that adrenergic alpha-antagonists increased the probability of stone expulsion by almost a third irrespective of the size of the stone. One meta-analysis compared adrenergic alpha-antagonists and showed that tamsulosin significantly decreased the stone expulsion time compared with doxazosin 4…”

Litíase Urinária E Sua Relação Com Os Achados De Cristalúria E Hematúria Na Urinálise

“…Dados populacionais norte-americanos mostram que, desde 1990, ocorreu um aumento de 91% nos atendimentos em serviços de emergência devido à nefrolitíase e, em afro-americanos, a prevalência da doença aumentou em 150% (de 1,7 para 4,5%) 3 . Nos últimos dez anos, reportou-se um aumento de quatro vezes no número de crianças acometidas por nefrolitíase e um aumento de sete vezes no diagnóstico de cálculos renais 4 . A maioria dos cálculos renais são cálcicos -oxalato de cálcio e fosfato de cálcio correspondem a aproximadamente 80% de todos os cálculos, ácido úrico corresponde a 9% dos cálculos, estruvita (fosfato amônio-magnesiano) corresponde a 10%, e 1% para o restante (cistina, medicamentos, amônia e urato ácido) 5 .…”