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Objective: To develop an evidence‐based recommendation concerning the use of α‐blockers for uncomplicated ureteric stones based on an up‐to‐date Cochrane review, as the role of medical expulsive therapy for uncomplicated ureteric stones remains controversial in the light of new contradictory trial evidence. Methods: We applied the Rapid Recommendations approach to guideline development, which represents an innovative approach by an international collaborative network of clinicians, researchers, methodologists and patient representatives seeking to rapidly respond to new, potentially practice‐changing evidence with recommendations developed according to standards for trustworthy guidelines. Results: The panel suggests the use of α‐blockers in addition to standard care over standard care alone in patients with uncomplicated ureteric stones (weak recommendation based on low‐quality evidence). The panel judged that the net benefit of α‐blockers was small and that there was considerable uncertainty about patients' values and preferences. This means that the panel expects that most patients would choose treatment with α‐blockers but that a substantial proportion would not. This recommendation applies to both patients in whom the presence of ureteric stones is confirmed by imaging, as well as patients in whom the diagnosis is made based on clinical grounds only. Conclusion: The Rapid Recommendations panel suggests the use of α‐blockers for patients with ureteric stones. Shared decision‐making is emphasised in making the final choice between the treatment options. [ABSTRACT FROM AUTHOR]

Objective: To assess the effects of α‐blockers compared to standard therapy or placebo for ureteric stones of ≤10 mm confirmed by imaging in adult patients presenting with symptoms of ureteric stone disease. Patients and Methods: We performed a systematic search in multiple databases and grey literature with no restrictions on the language of publication or publication status, up until November 2017. We included randomised controlled trials evaluating ureteric stone passage in adult patients that compared α‐blockers with standard therapy or placebo. Two review authors were independently responsible for study selection, data extraction, and risk‐of‐bias assessment. We performed a meta‐analysis using a random‐effect model. The quality of evidence was assessed on outcome basis according to Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results: We included 67 studies, with 10 509 participants overall. Of these, 15 studies with 5 787 participants used a placebo. Stone clearance: treatment with an α‐blocker may result in a large increase in stone clearance (risk ratio [RR] 1.45, 95% confidence interval [CI] 1.36–1.55; low‐quality evidence), corresponding to 278 more (95% CI: 223–340 more) stone clearances per 1 000 participants. For major adverse events, treatment with an α‐blocker may have little effect (RR 1.25, 95% CI: 0.80–1.96; low‐quality evidence), which corresponds to five more (95% CI four fewer to 19 more) major adverse events per 1 000 participants. Patients treated with α‐blockers may also experience shorter stone expulsion times (mean difference [MD] −3.40 days, 95% CI: −4.17 to −2.63; low‐quality evidence), use less diclofenac (MD −82.41 mg, 95% CI: −122.51 to −42.31; low‐quality evidence) and likely require fewer hospitalisations (RR 0.51, 95% CI: 0.34–0.77; moderate‐quality evidence). Meanwhile, the need for surgical intervention appears similar (RR 0.74, 95% CI: 0.53–1.02; low‐quality evidence). Based on a pre‐defined subgroup analysis (test for subgroup difference, P = 0.002), there may be a different effect of α‐blockers based on stone size with RRs of 1.06 (95% CI: 0.98–1.15; P = 0.16; I² = 62%) for stones of ≤5 mm vs 1.45 (95% CI: 1.22–1.72; P < 0.0001; I² = 59%) for stones of >5 mm. We did not find evidence for possible subgroup effects based on stone location or α‐blocker type. Conclusions: In patients with ureteric stones, α‐blockers likely increase stone clearance but probably also slightly increase the risk of major adverse events. Subgroup analyses suggest that α‐blockers may be less effective in smaller (≤5 mm) than larger stones (>5 mm). [ABSTRACT FROM AUTHOR]