Review: Alpha blockers helpful in treating kidney stones

December 1, 2016

Flomax isn’t just for the prostate.

That’s according to a new review published this week in The BMJ, suggesting that alpha blockers are also a beneficial treatment for patients who find themselves in the emergency room with a kidney stone that has dropped into their ureter, a thin tube that transports urine from the kidney to bladder. This medication appears to work particularly if the kidney stone is large.

The review, led by Philipp Dahm, MD, MHSc, Professor of Urology at University of Minnesota Medical School and staff physician at the Minneapolis VA Medical Center, systematically analyzed all 55 existing studies related to alpha blockers and ureteral stones. The goal: To clarify the uncertainty as to whether the muscle-relaxing medication – which is also widely used to treat men with prostate problems – helps patients pass their stone without surgery.

“Doctors have gotten really good at detecting kidney stones, which is the first step in helping patients,” Dahm said. “So the next logical step is improving the way we treat them, which requires this type of deep-dive research.”

Stones are mineral deposits that are formed in the kidney but can drop into the ureter and get lodged there. It’s a common, yet terribly painful experience that sends more than a million people to the emergency room each year.

Using scanning technology, doctors can assess the size of the deposit to determine treatment. Oftentimes, doctors will prescribe painkillers and send the patient home to pass the stone on their own. If that fails or the stone is too large, the patient may need surgery.

For more than 10 years, researchers have tried using this class of medication to help relax the ureter muscle and allow the deposit to pass through the body. While it appeared to work, a recent large, reputable study found no benefit over the standard of care, prompting many emergency room doctors to abandon the alpha blockers.

To resolve this lingering confusion, Dahm and colleagues systematically collected and analyzed the entire body of evidence to address this question. They found that patients with large stones who were treated with alpha blockers had a 57 percent higher chance of passing the stone, significantly less chance of surgical intervention and fewer episodes of pain.

“Based on the exhaustive analysis, we can now say that alpha blockers do work and help patients pass their stone,” Dahm said. “Alpha blockers are a conservative, less invasive approach, especially to help patients pass larger stones that may otherwise require surgical procedures. We believe our study provides compelling evidence to inform clinical practice and improve patient care.”