Abstract
We appreciate the comments of the respected reviewer. Various studies have been conducted for evaluating the role of α-blockers in assisting passage of lower ureteric stones, fragments resulting from SWL for renal and lower ureteral calculi, and fragments of steinstrasse. Tamsulosin has been the most commonly used medication; however, most studies have limitations in design, including sample size, heterogenecity of inclusion criteria, and lack of blinding and placebo-control, thereby lowering the strength of authenticity. Moreover, meta-analyses generated from such studies are similarly marred. Publication bias (file-drawer effect) and Simpson-effect are other limitations of meta-analysis. All factors combined lead to discrepancies between results of such meta-analysis and subsequent high quality large randomized controlled trials. 1 Agarwal M.S. Gupta M. Gupta A. et al. Prospective randomized trial comparing efficacy of alfuzosin and tamsulosin in management of lower ureteral stones. Urology. 2009; 73: 706-709 Abstract Full Text Full Text PDF PubMed Scopus (79) Google Scholar Therefore, meta-analyses which are not based on “best evidence” should be interpreted with caution. Is There an Adjunctive Role of Tamsulosin to Extracorporeal Shockwave Lithotripsy for Upper Ureteric Stones: Results of an Open Label Randomized Nonplacebo Controlled StudyUrologyVol. 74Issue 5PreviewTo investigate the role of tamsulosin as an adjunct to management of upper ureteric stones (UUS) with extracorporeal shock wave lithotripsy (SWL). Full-Text PDF Editorial CommentUrologyVol. 74Issue 5PreviewThere have been several publications that have looked at the efficacy of expulsive therapy for ureteric and indeed renal stones after SWL. The rationale of using α-1-adrenergic antagonists in medical expulsion therapy (MET) for the treatment of distal ureteral stones arose from the concept that they can induce selective relaxation of the ureteral smooth muscle. This inhibits ureteral spasms and results in dilatation of the ureteral lumen, increasing the fluid volume transported, and thereby helping expulsion of the stone. Full-Text PDF
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