Children who have kidney stones are likely to have recurrences. Many initial stones are treated conservatively allowing for spontaneous passage of small stones if possible. Doxazocin or tamsulosin are known to dilate the ureter and allow spontaneous passage of stones more easily in adults. Published results of medical expulsive therapy (MET) treatment for stones in children are variable. The authors of this paper carried out a meta-analysis using the Cochrane controlled trial register, MEDLINE and EMBASE databases, and recently presented abstracts (in any language) to determine if there is any support for MET in children. Inclusion criteria were age ≤ 18 years and the use of alpha blockers, calcium channel blockers or other adjuvant therapy (such as steroids or anticholinergics) to increase spontaneous passage of stones, comparing this treatment with non-MET drug treatment groups. The pooled results of 11,197 studies, of which 37 were selected for full review (five meeting the full inclusion criteria to be included in the pooled qualitative review and meta analysis – three randomised controlled trials and two retrospective cohorts) showed that, in the 456 patients in the meta-analysis, MET significantly increased the odds of spontaneous stone passage (OR 2.21, 95% CI, 1.4-3.49). There was no significant association between country of study, patient age or gender, or stone size. The five studies meeting the criteria for meta-analysis were from Turkey (two), Egypt (one) and USA (two). Mean stone size between these studies was between 3.8 and 7.4mm and mean patient age 5.7–14.5 years. Side-effects were sparse, mainly those of somnolence. The authors conclude that their meta-analysis supports the use of MET in treatment algorithms for paediatric urolithiasis. 

Medical expulsive therapy for pediatric urolithiasis: systematic review and meta-analysis. Velazquez N, Zapata D, Wang HH, et al.
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Henrik Steinbrecher

Southampton University Hospital NHS Trust

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