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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)?
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).
See table 1.
The incidence of renal stones in children is increasing.1–5 In adult patients, the use of medical expulsive therapy is well established to …
Contributors RMG: carried out the literature search and wrote the manuscript. TB, AT and RMG: reviewed the results and decided on papers to be included/excluded. TB and AT: reviewed the manuscript.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.