Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
What are the effects of alpha‐blockers as medical expulsive therapy for people with ureteral stones?
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and the intervention may be more effective/beneficial than the comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: Adults (mean age 32-56 years) with distal ureteral or mid and proximal ureteral stones
Intervention: Alpha-blockers
Comparison: Standard therapy or placebo
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Stone clearance (follow‐up: 1-8 weeks) | Favors intervention | Low |
Stone expulsion time (follow‐up: 1-8 weeks) | Favors intervention | Low |
Pain episodes (follow‐up: 2-6 weeks) | Favors intervention | Low |
Dose of diclofenac (nonsteroidal anti-inflammatory drug) | Favors intervention | Low |
Hospitalization (follow‐up: 2-4 weeks) | Favors intervention | Moderate |
Surgical intervention (follow‐up: 10 days-8 weeks) | No statistically significant difference | Low |
Major adverse events (follow‐up: 10-90 days) | No statistically significant difference | Low |
Note The Cochrane Clinical Answer (CCA) noted that subgroup analyses were carried out by stone size (≤5 mm, 6‐10 mm), ureteral position of stones (distal, mid/proximal), and type of alpha-blocker, and that most of the results were similar to the main analysis. However, for stones ≤5 mm there was no statistically significant difference in stone clearance, and for mid or proximal ureteral stones there was no statistically significant difference in expulsion time. The Cochrane review which underpins this CCA noted that the effectiveness of alpha-blockers is mostly related to stone size. Larger stones (>5mm) benefit the most from alpha-blockers since smaller stones often pass spontaneously. This has implications when considering using alpha-blockers if stone size has been accurately determined.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- What are the effects of alpha‐blockers as medical expulsive therapy for people with ureteral stones?
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