To help people get rid of large kidney stones, US Researchers have promoted a non-surgical way by suggesting off-label use of drugs called alpha blockers that can facilitate stone passage.
The study was published online in the British Medical Journal.
Physicians are eager to find non-surgical ways to help the two-thirds of kidney stone patients who need more than just extra hydration to pass their stones.
Contemporary practice guidelines recommend off-label use of drugs called alpha blockers to facilitate stone passage. These include drugs such as such as tamsulosin, known as Flomax.
However, a recent multicenter study of 1,136 subjects in the U.K. questioned the effectiveness of alpha blockers for this purpose.
Now, a new review of the medical literature suggests alpha blockers may be useful in some cases.
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"If we can facilitate kidney stone passage without surgery, it allows our patients to avoid extra pain and risks that come with a surgical procedure," says first author John M. Hollingsworth from University of Michigan Medical School in the US.
Hollingsworth and his team put that 2015 study into the context of other kidney stone research, pooling a total of 55 randomized controlled trials comparing alpha blockers to placebo or control.
They then considered stone size and location in the 5,990 study subjects to see if either one was a factor in successfully passing the stone.
"We found alpha blockers were successful, but the benefit is primarily in patients with larger kidney stones," says co-author Benjamin K. Canales, M.D., associate professor of urology at the University of Florida College of Medicine.
Researchers reported a 57 percent higher risk of stone passage for larger stones with an alpha blocker, but no benefit for smaller stones. Location did not make a difference, nor did type of alpha blocker used.
"This data helps me better identify the patients who are likely to benefit from alpha blockers," Hollingsworth says. "It's important to consider stone size when deciding whether to recommend alpha blockers to kidney stone patients."
Because so many providers see kidney stones, from urologists like Hollingsworth to emergency department physicians and primary care physicians, the treatment guidelines are especially important, he says.
"There had been a fair amount of ambiguity following the UK trial. However, our findings help solidify surrounding guideline recommendations on alpha blockers in patients with stones," Hollingsworth says.