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The Evidence Paradox of the Effectiveness between the Paediatric and Adult Stone-Forming Population: A Narrative

Andreas Bourdoumis, Leopold Durner, Claudius Füllhase

    Urologia Internationalis
    |January 23, 2019
    PubMed

    Insights

    Alpha-blockers show clearer effectiveness in pediatric urolithiasis treatment compared to adults. More rigorous, multi-institutional studies are needed to confirm medical expulsive treatment efficacy.

    Area of Science:

    • Urology
    • Pharmacology
    • Evidence-based medicine

    Background:

    • Alpha-blockers are utilized for medical expulsive treatment (MET) of urolithiasis.
    • Evidence for their effectiveness in pediatric populations requires further clarification.
    • Comparative analysis with adult data is essential to identify trends and discrepancies.

    Approach:

    • A comprehensive literature search identified randomized controlled trials in pediatric stone formers (≤18 years).
    • Key search terms included urolithiasis, MET, and specific alpha-blockers (alfuzosin, tamsulosin, doxazosin).
    • Outcomes assessed were stone expulsion rate, time to expulsion, pain episodes, and adverse events, with comparison to adult studies.

    Key Points:

    • While the pediatric evidence base for alpha-blockers in urolithiasis appears clearer, adult data presents inconsistencies.
    • Methodological variations across studies contribute to the observed paradox in treatment effectiveness.
    • Further research is crucial to establish reliable data on alpha-blocker efficacy in both pediatric and adult patients.

    Conclusions:

    • High-quality, multi-institutional, double-blind, placebo-controlled trials are necessary.
    • These studies should utilize realistic endpoints and standardized outcome measures.
    • The goal is to definitively prove the superiority of alpha-blockers over placebo in current clinical practice.
    Abstract

    Keywords:
    Medical expulsive treatmentPediatric populationα-Blocker/alfuzosin/tamsulosin/doxazosin

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