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Commentary on: Pickard R, Starr K, MacLennan G, et al. Use of drug therapy in the management of symptomatic ureteric stones in hospitalised adults: a multicentre, placebo-controlled, randomised controlled trial and cost-effectiveness analysis of a calcium channel blocker (nifedipine) and an alpha-blocker (tamsulosin) (the SUSPEND trial). Health Technol Assess 2015;19:1–172.
Symptomatic ureteric stones are a common urological problem with an annual incidence of around 30/100 000 population in high-resource countries.1 Usually stones sized <6 mm pass spontaneously and are therefore managed conservatively. Recent European Association of Urology guidelines (August 2015) recommend the use of medical expulsion therapy (MET), in the form of α-blockers, to facilitate small stone passage.2 This guidance is primarily based on the findings of a meta-analysis in 2009 which assessed 47 clinical trials.3 Two classes of MET were assessed, calcium channel blockers and α blockers. Although the conclusion of …
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