Aim/Objective: To identify trends in the evidence base regarding the effectiveness of using α-blockers in children versus adults and compare outcomes. Methods: A literature search up using the key words including urolithiasis/renal/ureteric stone in children/paediatric population, medical expulsive treatment (MET), α-blocker/alfuzosin/tamsulosin/doxazosin. Included were randomized or controlled clinical trials in paediatric stone formers (aged ≤18 years). Outcome measures for assessment included the overall stone expulsion rate, expulsion time, the number of pain episodes and adverse drug effects and/or reactions. Further comparison of efficacy levels using respective studies from the adult population was performed in order to identify trends, similarities and differences. Results: A total of 8,259 articles were identified. Full text evaluation was possible for 28 articles. Although the picture is clearer in the paediatric group, the lack of reproducible results in adults certainly poses serious questions about data collection, analysis and interpretation in each individual study. The apparent paradox is due to the methodological differences between studies. Conclusion: The effectiveness of α-blockers and other medication as MET needs to be studied in multi-institutional, double-blind, placebo-controlled studies that would aim to prove superiority to placebo in contemporary clinical situations, with realistic end points and standardized outcome measure determination.

Keywords:
Pediatric population, Medical expulsive treatment, α-Blocker/alfuzosin/tamsulosin/doxazosin
1.
Malek RS, Kelalis PP: Pediatric nephrolithiasis. J Urol 1975;113:545-551.
2.
Rizvi SA, Naqvi SA, Hussain Z, Hashmi A, Hussain M, Zafar MN, et al: Pediatric urolithiasis: developing nation perspectives. J Urol 2002;168(4 pt 1):1522-1525.
3.
Hesse A, Brändle E, Wilbert D, Köhrmann KU, Alken P: Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs. 2000. Eur Urol 2003;44:709-713.
4.
Tasian GE, Copelovitch L: Evaluation and medical management of kidney stones in children. J Urol 2014;192:1329-1336.
5.
Lahme S: Shockwave lithotripsy and endourological stone treatment in children. Urol Res 2006;34:112-117.
6.
Velázquez N, Zapata D, Wang HH, Wiener JS, Lipkin ME, Routh JC: Medical expulsive therapy for pediatric urolithiasis: Systematic review and meta-analysis. J Pediatr Urol 2015;11:321-327.
7.
Glina FP, Castro PM, Monteiro GG, Del Guerra GC, Glina S, Mazzurana M, Bernardo WM: The use of alpha-1 adrenergic blockers in children with distal ureterolithiasis: a systematic review and meta-analysis. Int Braz J Urol 2015;41:1049-1057.
8.
Mokhless I, Zahran AR, Youssif M, Fahmy A: Tamsulosin for the management of distal ureteral stones in children: a prospective randomized study. J Pediatr Urol 2012;8:544-548.
9.
Aydogdu O, Burgu B, Gucuk A, Suer E, Soygur T: Effectiveness of doxazosin in treatment of distal ureteral stones in children. J Urol 2009;182:2880-2884.
10.
Erturhan S, Bayrak O, Sarica K, Seckiner I, Baturu M, Sen H: Efficacy of medical expulsive treatment with doxazosin in pediatric patients. Urology 2013;81:640-643.
11.
Aldaqadossi HA, Shaker H, Saifelnasr M, Gaber M: Efficacy and safety of tamsulosin as a medical expulsive therapy for stones in children. Arab J Urol 2015;13:107-111.
12.
Tasian GE, Cost NG, Granberg CF, Pulido JE, Rivera M, Schwen Z, et al: Tamsulosin and spontaneous passage of ureteral stones in children: a multi-institutional cohort study. J Urol 2014;192:506-511.
13.
Atan A, Balcı M: Medical expulsive treatment in pediatric urolithiasis. Turk J Urol 2015;41:39-42.
14.
Hochwind C, Ashcroft K: Tamsulosin for ureteral stones - use in a pediatric population? Urol Nurs 2012;32:88-92.
15.
Cortes JA, Motamedinia P, Gupta M: Update on technological and selection factors influencing shockwave lithotripsy of renal stones in adults and children. Curr Opin Urol 2011;21:134-140.
16.
Van Savage JG, Palanca LG, Andersen RD, Rao GS, Slaughenhoupt BL: Treatment of distal ureteral stones in children: similarities to the american urological association guidelines in adults. J Urol 2000;164(3 pt 2):1089-1093.
17.
Pietrow PK, Pope JC 4th, Adams MC, Shyr Y, Brock JW 3rd: Clinical outcome of pediatric stone disease. J Urol 2002;167(2 pt 1):670-673.
18.
Nicoletta JA, Lande MB: Medical evaluation and treatment of urolithiasis. Pediatr Clin North Am 2006;53:479-491, vii.
19.
Homsy Y, Arnold P, Zhang W: Phase IIb/III dose ranging study of tamsulosin as treatment for children with neuropathic bladder. J Urol 2011;186:2033-2039.
20.
Kramer SA, Rathbun SR, Elkins D, Karnes RJ, Husmann DA: Double-blind placebo controlled study of alpha-adrenergic receptor antagonists (doxazosin) for treatment of voiding dysfunction in the pediatric population. J Urol 2005;173:2121-2124; discussion 2124.
21.
Yucel S, Akkaya E, Guntekin E, Kukul E, Akman S, Melikoglu M, Baykara M: Can alpha-blocker therapy be an alternative to biofeedback for dysfunctional voiding and urinary retention? A prospective study. J Urol 2005;174(4 pt 2):1612-1615; discussion 1615.
22.
Kroll P, Jankowski A, Maćkowiak J: [The comparative study on selective alpha1-blocker and behavioural therapy in the treatment of discoordinated voiding in children]. Przegl Lek 2006;63(suppl 3):226-228.
23.
Austin PF, Homsy YL, Masel JL, Cain MP, Casale AJ, Rink RC: Alpha-adrenergic blockade in children with neuropathic and nonneuropathic voiding dysfunction. J Urol 1999;162(3 pt 2):1064-1067.
24.
Vanderbrink BA, Gitlin J, Toro S, Palmer LS: Effect of tamsulosin on systemic blood pressure and nonneurogenic dysfunctional voiding in children. J Urol 2009;181:817-822; discussion 822.
25.
Cain MP, Wu SD, Austin PF, Herndon CD, Rink RC: Alpha blocker therapy for children with dysfunctional voiding and urinary retention. J Urol 2003;170(4 pt 2):1514-1515; discussion 1516-1517.
26.
Donohoe JM, Combs AJ, Glassberg KI: Primary bladder neck dysfunction in children and adolescents II: results of treatment with alpha-adrenergic antagonists. J Urol 2005;173:212-216.
27.
Yang SS, Wang CC, Chen YT: Effectiveness of alpha1-adrenergic blockers in boys with low urinary flow rate and urinary incontinence. J Formos Med Assoc 2003;102:551-555.
28.
Tsuda Y, Tatami S, Yamamura N, Tadayasu Y, Sarashina A, Liesenfeld KH, et al: Population pharmacokinetics of tamsulosin hydrochloride in paediatric patients with neuropathic and non-neuropathic bladder. Br J Clin Pharmacol 2010;70:88-101.
29.
Van Batavia JP, Combs AJ, Horowitz M, Glassberg KI: Primary bladder neck dysfunction in children and adolescents III: results of long-term alpha-blocker therapy. J Urol 2010;183:724-730.
30.
Molina Vázquez ME, Somoza Arguibay I, Palacios MG, Gómez Veiras JR, González M, Tellado M, et al: [Role of alpha antagonists in uncoordinated micturition syndrome in childhood]. Cir Pediatr 2010;23:236-240.
31.
McGuire EJ, Weiss RM: Secondary bladder neck obstruction in patients with urethral valves: treatment with phenoxybenzamine. Urology 1975;5:756-758.
32.
Austin P: The role of alpha blockers in children with dysfunctional voiding. ScientificWorldJournal 2009;9:880-883.
33.
Campschroer T, Zhu Y, Duijvesz D, Grobbee DE, Lock MT: Alpha-blockers as medical expulsive therapy for ureteral stones. Cochrane Database Syst Rev 2014;4:CD008509.
34.
Pickard R, Starr K, MacLennan G, Lam T, Thomas R, Burr J, et al: Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial. Lancet 2015;386:341-349.
35.
Skolarikos A, Grivas N, Kallidonis P, Mourmouris P, Rountos T, Fiamegos A, et al; Members of RISTA Study Group: The efficacy of medical expulsive therapy (MET) in improving stone-free rate and stone expulsion time, after extracorporeal shockwave lithotripsy (SWL) for upper urinary stones: a systematic review and meta-analysis. Urology 2015;86:1057-1064.
36.
Semins MJ, Matlaga BR: Strategies to optimize shockwave lithotripsy outcome: patient selection and treatment parameters. World J Nephrol 2015;4:230-234.
37.
Dogan HS, Altan M, Citamak B, Bozaci AC, Karabulut E, Tekgul S: A new nomogram for prediction of outcome of pediatric shock-wave lithotripsy. J Pediatr Urol 2015;11:84.e1-e6.
38.
Phillips B, Ball C, Sackett D, Badenoch D, Straus S, Haynes B, Dawes M: November 1998/Updated by Jeremy Howick March 2009. Oxford Centre for Evidence-Based Medicine - Levels of Evidence (May 2009). http://www.cebm.net/index.aspx?o=1025.
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