General

Clinical Question:
Do medications help the passage of kidney stones?

Bottom Line:
The limited amount of available data suggest that alpha blockers and calcium channel blockers appear to speed the passage of kidney stones. Furthermore, it appears that combining these medications with steroids provides additional benefit. (LOE = 1a-)

Reference:
Hollingsworth JM, Rogers MA, Kaufman SR, et al. Medical therapy to facilitate urinary stone passage: a meta-analysis. Lancet 2006;368:1171-1179.  [PMID:17011944]

Study Design:
Meta-analysis (randomized controlled trials)

Setting:
Various (meta-analysis)

Synopsis:
These authors searched multiple databases looking for randomized controlled trials of the effect of calcium channel blockers and alpha blockers on the passage of kidney stones. They also searched for unpublished studies. Two authors independently reviewed each study, assessed their quality, and extracted the data. Discrepancies were reconciled by consensus. The authors included 9 trials with a total of 693 patients in this study. Unfortunately, the authors don't report the doses of the drugs used in the included studies. In the 6 studies reporting time to stone passage, the range was as short as 6 days in several treatment groups to as long as 20 days in a control group. In 5 of those 6 trials, the treatment group had a shorter time to stone passage. The authors report that patients receiving active treatment had a 65% relative increased rate of stone passage compared with control patients. Based on the authors' estimates, we would need to treat 4 patients to facilitate the passage of 1 stone. A few studies also used steroids and the results suggest an additional benefit. Finally, the researchers report that most of the variability among the studies was attributable to variable inclusion criteria. Although they found no statistical evidence of publication bias, the authors are cautious about its potential.