Περίληψη:
Medical expulsive therapy (MET), in particular alpha-blockers, have been
recommended as supportive medication if observational treatment of a
ureteral stone was an option. Over the years, a considerable number of
randomized controlled trials (RCT) as well as several meta-analyses have
been published on MET, supporting the use of a-blockers. However,
several recently published high quality, large, placebo-controlled
randomized trials raised serious doubts about the effectiveness of
alpha-blockers. The contradictory results of meta-analyses of small RCTs
versus the findings of large, well conducted multicenter trials show the
methodological vulnerability of meta-analyses, in particular if small
single center, lower quality, papers have been included. Small single
center trials, for instance, tend to show larger treatment effects
compared to multicenter RCTs. It also shows the responsibility of
careful planning when conducting a RCT. Trial registration as a
prerequisite for approval by ethics committees could in addition
minimize publication bias. Weighting the current evidence on whether to
use MET, or not, it seems that in distal ureteral stones larger than 5
mm, there may be a potential therapeutic benefit for the use of
alpha-blockers. Patients should be informed about the possible, but as
yet unproven benefit of using alpha-blockers in this situation, as well
as their off-label use and potential side effects. (C) 2016 European
Association of Urology. Published by Elsevier B.V. All rights reserved.
Συγγραφείς:
Tuerk, Christian
Knoll, Thomas
Seitz, Christian
Skolarikos,
Andreas
Chapple, Chris
McClinton, Sam
European Ass Urology
