Summary of findings for the main comparison. Alpha‐blockers compared with standard therapy for ureteral stones.

Alpha‐blockers compared with standard therapy for ureteral stones
Patient or population: adult patients presenting with symptoms of ureteral stone disease Setting: single or multicenter Intervention: alpha‐blocker Comparison: standard therapy
Outcomes	No. of participants (studies) Follow‐up	Quality of the evidence (GRADE)	Relative effect (95% CI)	Anticipated absolute effects* (95% CI)
				Risk with standard therapy	Risk difference with alpha‐blockers
Stone clearance	10509 (67 RCTs)	⊕⊕⊝⊝ LOWa,b,c	RR 1.45 (1.36 to 1.55)	Study population
				619 per 1000	278 more per 1000 (223 more to 340 more)
Major adverse events	3124 (18 RCTs)	⊕⊕⊝⊝ LOWa,d	RR 1.25 (0.80 to 1.96)	Study population
				20 per 1000	5 more per 1000 (4 fewer to 19 more)
Stone expulsion time	6031 (37 RCTs)	⊕⊕⊝⊝ LOWa,c,e	‐		MD 3.4 lower (4.17 lower to 2.63 lower)
Pain episodes	1363 (15 RCTs)	⊕⊕⊝⊝ LOWa,c,f	‐		MD 0.66 lower (0.91 lower to 0.42 lower)
Dose of diclofenac	4373 (14 RCTs)	⊕⊕⊝⊝ LOWa,c,g	‐		MD 82.41 mg lower (122.51 lower to 42.31 lower)
Hospitalisation	1876 (13 RCTs)	⊕⊕⊕⊝ MODERATEa	RR 0.51 (0.34 to 0.77)	Study population
				141 per 1000	69 fewer per 1000 (93 fewer to 32 fewer)
Surgical intervention	3292 (19 RCTs)	⊕⊕⊝⊝ LOWa,d	RR 0.74 (0.53 to 1.02)	Study population
				109 per 1000	28 fewer per 1000 (51 fewer to 2 more)
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio.
GRADE Working Group grades of evidence. High certainty: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

^aMost studies were rated as having high or unclear risk of bias.

^bClinically important heterogeneity with I² of 76%; provided rationale for downgrading together with suspected publication bias.

^cPublication bias suspected given funnel plot asymmetry.

^dConfidence interval consistent; no effect and clinically important harm.

^eClinically important heterogeneity with I² of 94%; provided rationale for downgrading together with suspected publication bias.

^fClinically important heterogeneity with I² of 80%; provided rationale for downgrading together with suspected publication bias.

^gClinically important heterogeneity with I² of 100%; provided rationale for downgrading together with suspected publication bias.