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Question 1: Are alpha-antagonists useful in promoting the passage of renal stones in children?
  1. Rhoda Mary Greeves1,2,
  2. Andrew Thompson2,
  3. Thomas Bourke3
  1. 1 Department of Paediatrics, South Eastern Health and Social Care Trust, Belfast, UK
  2. 2 Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
  3. 3 Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
  1. Correspondence to Dr Rhoda Mary Greeves, Paediatrics, South Eastern Health and Social Care Trust, Belfast BT16 1RH, UK; rgreeves01{at}qub.ac.uk

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Scenario

A 10-year-old boy presented with a 1-week history of crampy abdominal pain and haematuria. He complained of flank tenderness and the abdominal X-ray and ultrasound of his abdomen suggested a left renal stone. This was confirmed on CT scan as 3 mm in size. At a handover meeting, it was suggested that alpha-antagonists, which are often used in adult patients, could be used in the treatment of this child. You wonder whether these are better than conservative medical management.

Structured clinical question

In children with renal stones (population) does treatment with an alpha blocker (intervention) compared with conservative medical management with analgesia alone (comparison) increase stone expulsion rate (outcome)?

Search

We searched PubMed on 14 March 2018 using the terms (paediatric OR pediatric OR child) AND (renal calculi OR renal stone OR nephrolithiasis OR urolithiasis OR ureteric stone OR ureteric calculi) AND (alpha blocker OR doxazosin OR tamsulosin). Non-paediatric studies and those which looked at the use of alpha-antagonists after shock wave lithotripsy were excluded. Twenty-one papers were found and assessed and 17 qualified for further review. Nine were found to be relevant on abstract review, of which four were systematic reviews. Five of these relevant papers were not included as they had been included in the systematic review articles. A total of four systematic reviews were subsequently analysed (table 1).

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Table 1

Summary of included articles

Summary

See table 1.

Commentary

The incidence of renal stones in children is increasing.1–5 In adult patients, the use of medical expulsive therapy is well established to …

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