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Alpha-blockers: the magic pill for endourology—The great delusion

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Abstract

Purpose

The present paper takes a different and more critical look at the role of alpha-blockers, sometimes nicknamed as “magical pills”, in particular for stone disease and medical expulsive therapy (MET).

Methods

A non-systematic narrative review was performed, synthesizing pertinent information from selected articles, and critically evaluating their conclusions. Sometimes different views on alpha-blockers were laid bare, including curiosities or other entertaining nuances suitable to the present topic, but always maintaining sharp objectivity and the foremost scientific rigor.

Results and Conclusions

Alpha-blockers seem to be a panacea, being used to treat a wide variety of non-urological diseases and conditions. Urological applications include erectile dysfunction to benign prostatic hyperplasia, from incontinence to urinary retention, or even to facilitate urinary stone passage along the urinary tract. Due to its versatility, alpha-blockers appear to be the Swiss army knife of urological medications. However, the efficacy of alpha-blockers for MET, pain management, or facilitating upper tract access is very disappointing, bringing no, or in some instances, only marginal benefits. Their treatment results are far from being significant or impressive let alone magical. Regular sexual intercourse is an effective alternative to alpha-blockers, providing faster ureteral stone expulsion rates and reducing the need for pain medication. Most of the research supporting alpha-blockers has been based on single-center, underpowered, low-quality studies. These low-quality studies biased several subsequent meta-analyses, contaminating them with their low-quality data, enhancing and prolonging this delusion. These results emphasize the need for large, multi-centric, unbiased, randomized, double-blinded, placebo-controlled trials to prevent future year-long delusions that may afflict any medical field.

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References

  1. Dellabella M, Milanese G, Muzzonigro G (2003) Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J Urol 170(6 Pt 1):2202–2205. https://doi.org/10.1097/01.ju.0000096050.22281.a7

    Article  CAS  PubMed  Google Scholar 

  2. Tonyali S (2019) Alpha-blockers are widely used in medical expulsion therapy for ureteral stones besides management of lower urinary tract symptoms. World J Urol 37(9):1981. https://doi.org/10.1007/s00345-018-2572-4

    Article  PubMed  Google Scholar 

  3. Aboumarzouk OM, Jones P, Amer T, Kotsiris D, Emiliani E, Somani B, Kallidonis P et al (2018) What Is the role of α-blockers for medical expulsive therapy? Results from a meta-analysis of 60 randomized trials and over 9500 patients. Urology 119:5–16. https://doi.org/10.1016/j.urology.2018.03.028

    Article  PubMed  Google Scholar 

  4. Tao R-Z, Qin Z-Q, Liu F, Lv J-L (2019) Efficacy and safety of tamsulosin in the medical expulsion therapy for distal ureteral calculi: a systematic review and meta-analysis of placebo-controlled trials. Urol J 16(3):224–31. https://doi.org/10.22037/uj.v0i0.4758

  5. John TT, Razdan S (2010) Adjunctive tamsulosin improves stone free rate after ureteroscopic lithotripsy of large renal and ureteric calculi: a prospective randomized study. Urology 75(5):1040–1042. https://doi.org/10.1016/j.urology.2009.07.1257

    Article  PubMed  Google Scholar 

  6. DiBianco JM, Conrado B, Daignault-Newton S, Witzke K, Wenzler D, Pimentel H, Ghani KR et al (2023) Practice patterns and outcomes of urgent versus elective ureteroscopy in a statewide surgical collaborative. World J Urol 41(1):221–227. https://doi.org/10.1007/s00345-022-04203-z

    Article  PubMed  Google Scholar 

  7. Bhattar R, Jain V, Tomar V, Yadav SS (2017) Safety and efficacy of silodosin and tadalafil in ease of negotiation of large ureteroscope in the management of ureteral stone: a prospective randomized trial. Turkish J Urol 43(4):484–489. https://doi.org/10.5152/tud.2017.83548

    Article  Google Scholar 

  8. Arda E, Cakiroglu B, Yuksel I, Akdeniz E, Cetin G (2017) Medical expulsive therapy for distal ureteral stones: tamsulosin versus silodosin in the Turkish population. Cureus 9(11):e1848. https://doi.org/10.7759/cureus.1848

    Article  PubMed  PubMed Central  Google Scholar 

  9. Türk C, Knoll T, Seitz C, Skolarikos A, Chapple C, McClinton S (2017) Medical expulsive therapy for ureterolithiasis: The EAU recommendations in 2016. Eur Urol 71(4):504–507. https://doi.org/10.1016/j.eururo.2016.07.024

    Article  PubMed  Google Scholar 

  10. Diodore de Sicile A, Macault) Les Trois premiers Livres de l’Histoire de Diodore Sicilien, historiographe grec translatez de latin en françoys par maistre Anthoine Macault. Paris: Arnoul et Charles L’Angelier; 1540

  11. Berthelot M, Ruelle C-É, Démocrite) Collection des anciens alchimistes grecs. Paris: G. Steinheil; 1887–1888

  12. Laurent S (2017) Antihypertensive drugs. Pharmacol Res 124:116–125. https://doi.org/10.1016/j.phrs.2017.07.026

    Article  CAS  PubMed  Google Scholar 

  13. Das S, Kumar P, Kiran U, Airan B (2017) Alpha blockers: a relook at phenoxybenzamine. J Pract Cardiovasc Sci 3(1):11. https://doi.org/10.4103/jpcs.jpcs_42_16

    Article  Google Scholar 

  14. Bristow MR (2000) beta-adrenergic receptor blockade in chronic heart failure. Circulation 101(5):558–569. https://doi.org/10.1161/01.CIR.101.5.558

    Article  CAS  PubMed  Google Scholar 

  15. Bakst R, Merola JF, Franks AG, Sanchez M (2008) Raynaud’s phenomenon: pathogenesis and management. J Am Acad Dermatol 59(4):633–653. https://doi.org/10.1016/j.jaad.2008.06.004

    Article  PubMed  Google Scholar 

  16. Koola MM, Varghese SP, Fawcett JA (2014) High-dose prazosin for the treatment of post-traumatic stress disorder. Therap Adv Psychopharmacol 4(1):43–47. https://doi.org/10.1177/2045125313500982

    Article  Google Scholar 

  17. Lue TF (2000) Erectile dysfunction. N Engl J Med 342(24):1802–1813. https://doi.org/10.1056/NEJM200006153422407

    Article  CAS  PubMed  Google Scholar 

  18. The Italian Alfuzosin Cooperative Group (1995) Multicenter observational trial on symptomatic treatment of benign prostatic hyperplasia with alfuzosin: clinical evaluation of impact on patient’s quality of life. The Italian Alfuzosin Cooperative Group. Eur Urol 27(2):128–34. https://doi.org/10.1159/000475143.

  19. Kroczak T, Scotland KB, Chew B, Pace KT (2017) Shockwave lithotripsy: techniques for improving outcomes. World J Urol 35(9):1341–1346. https://doi.org/10.1007/s00345-017-2056-y

    Article  PubMed  Google Scholar 

  20. Al-Ansari A, Al-Naimi A, Alobaidy A, Assadiq K, Azmi MD, Shokeir AA (2010) Efficacy of tamsulosin in the management of lower ureteral stones: a randomized double-blind placebo-controlled study of 100 patients. Urology 75(1):4–7. https://doi.org/10.1016/j.urology.2009.09.073

    Article  PubMed  Google Scholar 

  21. Molina WR, Catarinicchia SP (2019) Medical expulsive therapy for ureteral stones: is it still worthwhile? Ann Emerg Med 73(3):313–314. https://doi.org/10.1016/j.annemergmed.2018.07.003

    Article  PubMed  Google Scholar 

  22. Ahmed A-F, Shalaby E, El-Feky M, Kotb A, Elsotohi E, El-Kholy M, Ragab A et al (2016) Role of tamsulosin therapy after extracorporeal shockwave lithotripsy for renal stones: randomized controlled trial. Urol Int 97(3):266–272. https://doi.org/10.1159/000445840

    Article  CAS  PubMed  Google Scholar 

  23. Hermanns T, Sauermann P, Rufibach K, Frauenfelder T, Sulser T, Strebel RT (2009) Is there a role for tamsulosin in the treatment of distal ureteral stones of 7 mm or less? Results of a randomised, double-blind, placebo-controlled trial. Eur Urol 56(3):407–412. https://doi.org/10.1016/j.eururo.2009.03.076

    Article  CAS  PubMed  Google Scholar 

  24. Theriault B, Morin F, Cloutier J (2020) Safety and efficacy of Tamsulosin as medical expulsive therapy in pregnancy. World J Urol 38(9):2301–2306. https://doi.org/10.1007/s00345-019-03022-z

    Article  PubMed  Google Scholar 

  25. Kroczak T, Pace KT, Lee JY (2017) Medical expulsive therapy: worthwhile or wishful thinking. Curr Urol Rep 18(4):29. https://doi.org/10.1007/s11934-017-0673-z

    Article  PubMed  Google Scholar 

  26. Ferre RM, Wasielewski JN, Strout TD, Perron AD (2009) Tamsulosin for ureteral stones in the emergency department: a randomized, controlled trial. Ann Emerg Med 54(3):432–9, 439.e1–2. https://doi.org/10.1016/j.annemergmed.2008.12.026.

  27. Amer T, Osman B, Johnstone A, Mariappan M, Gupta A, Brattis N, Jones G et al (2017) Medical expulsive therapy for ureteric stones: analysing the evidence from systematic reviews and meta-analysis of powered double-blinded randomised controlled trials. Arab J Urol 15(2):83–93. https://doi.org/10.1016/j.aju.2017.03.005

    Article  PubMed  PubMed Central  Google Scholar 

  28. Itoh Y, Okada A, Yasui T, Ando R, Tozawa K, Sasaki S, Kohri K (2013) Administration of the selective alpha 1A-adrenoceptor antagonist silodosin facilitates expulsion of size 5–10 mm distal ureteral stones, as compared to control. Int Urol Nephrol 45(3):675–678. https://doi.org/10.1007/s11255-013-0429-8

    Article  CAS  PubMed  Google Scholar 

  29. Falahatkar S, Akhavan A, Esmaeili S, Amin A, Kazemnezhad E, Jafari A (2021) Efficacy of tamsulosin versus tadalafil as medical expulsive therapy on stone expulsion in patients with distal ureteral stones: A randomized double-blind clinical trial. Int Braz J Urol 47(5):982–988. https://doi.org/10.1590/S1677-5538.IBJU.2020.1007

    Article  PubMed  PubMed Central  Google Scholar 

  30. Boutron I, Ravaud P (2018) Misrepresentation and distortion of research in biomedical literature. Proc Natl Acad Sci USA 115(11):2613–2619. https://doi.org/10.1073/pnas.1710755115

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  31. Berger DA, Ross MA, Hollander JB, Ziadeh J, Chen C, Jackson RE, Swor RA (2015) Tamsulosin does not increase 1-week passage rate of ureteral stones in ED patients. Am J Emerg Med 33(12):1721–4. https://doi.org/10.1016/j.ajem.2015.08.006.

  32. Ahmed A-F, Maarouf A, Shalaby E, Alshahrani S, El-Feky M, Khaled S, Daoud A et al (2017) Semi-rigid ureteroscopy for proximal ureteral stones: does adjunctive tamsulosin therapy increase the chance of success? Urol Int 98(4):411–417. https://doi.org/10.1159/000452926

    Article  CAS  PubMed  Google Scholar 

  33. Alsaikhan B, Koziarz A, Lee JY, Pace KT (2020) Preoperative alpha-blockers for ureteroscopy for ureteral stones: a systematic review and meta-analysis of randomized controlled trials. J Endourol 34(1):33–41. https://doi.org/10.1089/end.2019.0520

    Article  PubMed  Google Scholar 

  34. Kaler KS, Safiullah S, Lama DJ, Parkhomenko E, Okhunov Z, Ko YH, Huynh L et al (2018) Medical impulsive therapy (MIT): the impact of 1 week of preoperative tamsulosin on deployment of 16-French ureteral access sheaths without preoperative ureteral stent placement. World J Urol 36(12):2065–2071. https://doi.org/10.1007/s00345-018-2336-1

    Article  CAS  PubMed  Google Scholar 

  35. Assimos DG (2020) Re: preoperative alpha-blockers for ureteroscopy for ureteral stones: a systematic review and meta-analysis of randomized controlled trials. J Urol 203(4):657–658. https://doi.org/10.1097/JU.0000000000000727.02

    Article  PubMed  Google Scholar 

  36. Hashem A, El-Assmy AM, Sharaf DE, Elgamal M, Elzalouey AE, Laymon M (2022) A randomized trial of adjuvant tamsulosin as a medical expulsive therapy for renal stones after shock wave lithotripsy. Urolithiasis 50(4):473–480. https://doi.org/10.1007/s00240-022-01330-5

    Article  CAS  PubMed  Google Scholar 

  37. Benítez Camps M, Cerain Herrero MJ, de Miguel Llorente N, Martorell Sole E, Flores Mateo G, Pedro Pijoan AM, Murillo-Huapaya C (2015) Eficacia y seguridad de tamsulosina para el tratamiento conservador del cólico nefrítico: revisión sistemática con metaanálisis de ensayos clínicos aleatorizados. Med Clin 145(6):239–247. https://doi.org/10.1016/j.medcli.2015.01.029

    Article  Google Scholar 

  38. Campschroer T, Zhu X, Vernooij RWM, Lock TMTW (2018) α-blockers as medical expulsive therapy for ureteric stones: a Cochrane systematic review. BJU Int 122(6):932–945. https://doi.org/10.1111/bju.14454

    Article  CAS  PubMed  Google Scholar 

  39. Basri C, Sinanoglu O, Mahmure U (2013) The effect of tamsulosin on pain and clearance according to ureteral stone location after shock wave lithotripsy. Curr Ther Res Clin Exp 74:33–35. https://doi.org/10.1016/j.curtheres.2012.12.003

    Article  CAS  Google Scholar 

  40. Agarwal MM, Naja V, Singh SK, Mavuduru R, Mete UK, Kumar S, Mandal AK (2009) Is there an adjunctive role of tamsulosin to extracorporeal shockwave lithotripsy for upper ureteric stones: results of an open label randomized nonplacebo controlled study. Urology 74(5):989–992. https://doi.org/10.1016/j.urology.2009.06.075

    Article  PubMed  Google Scholar 

  41. Abdel-Kader MS (2017) Evaluation of the efficacy of sexual intercourse in expulsion of distal ureteric stones. Int Urol Nephrol 49(1):27–30. https://doi.org/10.1007/s11255-016-1448-z

    Article  MathSciNet  PubMed  Google Scholar 

  42. Bayraktar Z, Albayrak S (2017) Sexual intercourse as a new option in the medical expulsive therapy of distal ureteral stones in males: a prospective, randomized, controlled study. Int Urol Nephrol 49(11):1941–1946. https://doi.org/10.1007/s11255-017-1677-9

    Article  CAS  PubMed  Google Scholar 

  43. Doluoglu OG, Demirbas A, Kilinc MF, Karakan T, Kabar M, Bozkurt S, Resorlu B (2015) Can sexual intercourse be an alternative therapy for distal ureteral stones? A prospective, randomized. Controll Study Urol 86(1):19–24. https://doi.org/10.1016/j.urology.2015.03.037

    Article  Google Scholar 

  44. Juman C, Bruce A, Kwan TY, Krishan A, Ehsanullah SAM, Khashaba S, Rafie MA (2021) Comparison of the efficacy of male sexual activity versus alpha-blockers in the expulsion of distal ureteric stones: a systematic review and meta-analysis. Cureus 13(11):e19347. https://doi.org/10.7759/cureus.19347

    Article  PubMed  PubMed Central  Google Scholar 

  45. Turgut H (2021) Evaluation of the efficacy of sexual intercourse on distal ureteral stones in women: a prospective, randomized, controlled study. Int Urol Nephrol 53(3):409–413. https://doi.org/10.1007/s11255-020-02661-1

    Article  PubMed  Google Scholar 

  46. Turgut H, Sarıer M (2021) Evaluation of the efficacy of masturbation on distal ureteral stones: a prospective, randomized, controlled study. Int Urol Nephrol 53(4):655–660. https://doi.org/10.1007/s11255-020-02672-y

    Article  CAS  PubMed  Google Scholar 

  47. Wilson L, Patel AB (2006) Renal colic during sexual intercourse: a unique presentation. Urol Res 34(3):225–226. https://doi.org/10.1007/s00240-006-0039-3

    Article  CAS  PubMed  Google Scholar 

  48. Montaigne Md) Essais de messire Michel, seigneur de Montaigne. Bourdeaus: impr. S. Millanges; 1580.

  49. Sinsomboon O, Noppakulsatit P, Tassanarong A, Tungsukruthai P, Sriyakul K (2022) A comparison of effectiveness of thai traditional massage and tamsulosin in lower urinary tract symptoms: a randomized controlled trial. J Evid Based Integrat Med. https://doi.org/10.1177/2515690X211068825

    Article  Google Scholar 

  50. Sinsomboon O, Kuendee N, Naladta A, Sriyakul K, Sukprasert S (2023) Thai traditional massage modulates urinary MCP-1 and relevant inflammatory biomarkers in lower urinary tract symptom patients. J Tradit Complement Med. https://doi.org/10.1016/j.jtcme.2023.06.001

    Article  PubMed  PubMed Central  Google Scholar 

  51. Meltzer AC, Burrows PK, Wolfson AB, Hollander JE, Kurz M, Kirkali Z, Kusek JW et al (2018) Effect of tamsulosin on passage of symptomatic ureteral stones: a randomized clinical trial. JAMA Int Med 178(8):1051–1057. https://doi.org/10.1001/jamainternmed.2018.2259

    Article  Google Scholar 

  52. Bayar G, Yavuz A, Cakmak S, Ofluoglu Y, Kilinc MF, Kucuk E, Aydın M (2020) Efficacy of silodosin or mirabegron in medical expulsive therapy for ureteral stones: a prospective, randomized-controlled study. Int Urol Nephrol 52(5):835–840. https://doi.org/10.1007/s11255-019-02368-y

    Article  CAS  PubMed  Google Scholar 

  53. Yu Z-W, Wang R-H, Zhang C-C, Gao J-G (2021) The efficacy and safety of alpha-adrenergic blockers for medical expulsion therapy in patients with ureteral calculi: A meta-analysis of placebo-controlled trials. Medicine 100(37):e27272. https://doi.org/10.1097/MD.0000000000027272

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Brain E, Geraghty RM, Tzelves L, Mourmouris P, Chatzikrachtis N, Karavitakis M, Skolarikos A et al (2022) Outcomes of alpha-blockers as medical expulsive therapy following shockwave lithotripsy: a systematic review and meta-analysis. BJU Int. https://doi.org/10.1111/bju.15901

    Article  PubMed  Google Scholar 

  55. Oestreich MC, Vernooij RW, Sathianathen NJ, Hwang EC, Kuntz GM, Koziarz A, Scales CD et al (2020) Alpha-blockers after shock wave lithotripsy for renal or ureteral stones in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD013393

    Article  PubMed  PubMed Central  Google Scholar 

  56. European Association of Urology, editor) EAU Guidelines. Edn. presented at the EAU Annual Congress Milan; 2023

  57. Pickard R, Starr K, MacLennan G, Kilonzo M, Lam T, Thomas R, Burr J et al (2015) Use of drug therapy in the management of symptomatic ureteric stones in hospitalised adults: a multicentre, placebo-controlled, randomised controlled trial and cost-effectiveness analysis of a calcium channel blocker (nifedipine) and an alpha-blocker (tamsulosin) (the SUSPEND trial). Health Technol Assessment (Winchester, England) 19(63):vii–viii, 1–171. https://doi.org/10.3310/hta19630

  58. Sur RL, Shore N, L’Esperance J, Knudsen B, Gupta M, Olsen S, Shah O (2015) Silodosin to facilitate passage of ureteral stones: a multi-institutional, randomized, double-blinded, placebo-controlled trial. Eur Urol 67(5):959–964. https://doi.org/10.1016/j.eururo.2014.10.049

    Article  CAS  PubMed  Google Scholar 

  59. Furyk JS, Chu K, Banks C, Greenslade J, Keijzers G, Thom O, Torpie T et al (2016) Distal ureteric stones and tamsulosin: a double-blind, placebo-controlled, randomized. Multicenter trial. Annals Emerg Med 67(1):86-95.e2. https://doi.org/10.1016/j.annemergmed.2015.06.001

    Article  Google Scholar 

  60. Amer T, Jones G, Aboumarzouk O (2017) Medical expulsive therapy: is it time to SUSPEND judgement? Drugs 77(8):809–812. https://doi.org/10.1007/s40265-017-0721-5

    Article  PubMed  Google Scholar 

  61. de Coninck V, Antonelli J, Chew B, Patterson JM, Skolarikos A, Bultitude M (2019) Medical expulsive therapy for urinary stones: future trends and knowledge gaps. Eur Urol 76(5):658–666. https://doi.org/10.1016/j.eururo.2019.07.053

    Article  CAS  PubMed  Google Scholar 

  62. Ambani SN, Ghani KR (2016) Stones in 2015: changes in stone management - suspending belief for evidence. Nat Rev Urol 13(2):71–72. https://doi.org/10.1038/nrurol.2015.290

    Article  PubMed  Google Scholar 

  63. Allen H (1926) The Anti-Evolution Campaign in America. Current History (1916–1940) 24(6):893–897

  64. Dennex Science) Flat Earth Society: Members around the Globe!: Independently Published; 2019

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  1. CUF Descobertas Hospital, Member of PETRA UroGroup (Progress in Endourology, Technology and Research Association), Lisbon, Portugal

    Peter Kronenberg

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Kronenberg, P. Alpha-blockers: the magic pill for endourology—The great delusion. World J Urol 42, 109 (2024). https://doi.org/10.1007/s00345-024-04785-w

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