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Randomised controlled trial
Tamsulosin and nifedipine did not improve stone passage over placebo nor were they cost-effective in ureteric stone disease
  1. Sayyid M Ammar Raza,
  2. Philip A Kalra
  1. Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
  1. Correspondence to : Philip A Kalra, Department of Renal Medicine, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK; Philip.kalra{at}

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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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