Does Medical Therapy Aid in the Passage of Ureteral Stones?

A meta-analysis indicates that it may.

Several small clinical trials have suggested that the likelihood that patients will pass ureteral stones spontaneously can be increased by calcium-channel blockers or -adrenergic blockers. Both of these drug classes are thought to relax ureteral smooth muscle in the region of the stone.

Investigators performed a meta-analysis of nine diverse trials in which 693 patients with ureteral stones (mean diameter, 3.9 to 7.8 mm) were randomized to receive calcium-channel blockers, -blockers, or no expulsive therapy for 1 to 6 weeks and were followed for 15 to 48 days. In three trials, treated patients received corticosteroids in addition to nifedipine; in seven trials, both treated and control groups received nonsteroidal anti-inflammatory drugs (NSAIDs). Spontaneous stone passage occurred more often in the treatment groups than in the control groups in all nine trials (overall risk ratio, 1.65); in seven trials, this difference was significant. Analyses of these trials when grouped by treatment, as well as analyses including five additional trials that were excluded for absence of true controls, produced similar results. Statistical analysis suggested that publication bias was unlikely.

Comment: Because calcium-channel blockers and -blockers are generally well-tolerated, the authors suggest that medical expulsive therapy should be included in conservative management of patients with urolithiasis, because it may avert surgery or lithotripsy — each of which carries considerable risk and expense. The studies reviewed here were small, used different interventions, and were of varying quality. A large, well-designed randomized trial would be more conclusive.

— Bruce Soloway, MD

Published in Journal Watch October 26, 2006

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