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Efficacy and Safety of Tamsulosin in the Medical Expulsion Therapy for Distal Ureteral Calculi: A Systematic Review and Meta-Analysis of Placebo-Controlled Trials

Rong-zhen Tao, Zhi-qiang Qin, Fa-de Liu, Jian-lin Lv
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Abstract

Purpose: Tamsulosin, a medical expulsive therapy (MET), was always recommended for patients with distal ure­teral calculi less than 10 mm. The aim of the systematic review was to assess the efficacy and safety of tamsulosin in MET compared with placebo.

Materials and Methods: A comprehensive search was conducted in the databases PubMed, EMBASE and Web of Science for relevant articles, covering all the literatures published until April 2018. All placebo controlled trails were identified in which patients were randomized to receive either tamsulosin or placebo for distal ureteral calculi.

Results: A total of seven placebo controlled studies including 4135 patients met the inclusion criteria and were involved in the review. We found that tamsulosin was associated with a significantly higher expulsion rate (ESR) [odds ratio (OR) = 1.10, 95% confidence interval (CI) = 1.00-1.21] than placebo in patients with distal ureteral stones less than 7 mm. The ESR ranged from 67.0%-90.7%. But the significant difference was better seen in pa­tients with distal ureteral stones less than 10 mm (OR = 1.11, 95% CI = 1.01-1.21). Even though tamsulosin has a higher incidence of retrograde ejaculation than placebo, no significant difference was observed in the incidence of other adverse events.

Conclusion: The results of the current meta-analysis indicated that tamsulosin was superior to placebo in its effi­cacy for distal ureteral stones though retrograde ejaculation was worse with tamsulosin use. It should be a safe and effective medical expulsive therapy choice for distal ureteral stones when stone sizes are less than 10 mm.


References

Stefanos PJ, Michael C: Trussa: Treatment strategies of ureteral stones. EAU-EBU Update Series 2006; 4: 184-190.

Scales CD, Smith AC, Hanley JM, et al; Project Urologic Diseases in America. Prevalence of kidney stones in the United States. Eur Urol. 2012;62:160-165.

Menon M, Parulkar BC, Drash GW, et al: Urinary lithiasis: etiology, diagnosis, diagnosis and medical management; in Walsh PC (ed): Campbell’s Urology. Philadelphia, Saunders, 1998, pp 2661–2733.

Colella J, Kochis E, Galli B, Munver R. Urolithiasis/nephrolithiasis: what’s it all about? Urol Nurs 2005; 25: 427–48; 475, 449.

Preminger GM, Tiselius HG, Assimos DG, et al. 2007 guideline for the management of ureteral calculi. J Urol 2007; 178: 2418-2434.

Türk C, Petrík A, Sarica K, et al. EAU guidelines on diagnosis and conservative management of urolithiasis. Eur Urol. 2016;69:468-474.

Cervenakov I, Fillo J, Mardiak J, Kopecny M, Smirala J, Lepies P. Speedy elimination of ureterolithiasis in lower part of ureters with the alpha 1-blocker-tamsulosin. Int Urol Nephrol 2002; 34: 25–9.

Dellabella M, Milanese G, Muzzonigro G. Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J Urol 2003; 170: 2202–5.

Ye Z, Zeng G, Yang H, et al. Efficacy and Safety of Tamsulosin in Medical Expulsive Therapy for Distal Ureteral Stones with Renal Colic: A Multicenter, Randomized, Double-blind, Placebo-controlled Trial. Eur Urol (2017), https://doi.org/ 10.1016/j.eururo.2017.10.033.

Lu Z, Dong Z, Ding H, et al. Tamsulosin for Ureteral Stones: A Systematic Review and Meta-Analysis of a Randomized Controlled Trial. Urol Int 2012;89:107-115.

Wang RC, Smith-Bindman R, Whitaker E, et al. Effect of Tamsulosin on Stone Passage for Ureteral Stones: A Systematic Review and Meta-analysis. Ann Emerg Med 2017 Mar ;69(3).

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration. BMJ. 2009;339:b2700.

OCEBM Levels of Evidence Working Group. The Oxford Levels of Evidence 1. Oxford Centre for Evidence-Based Medicine. [Last accessed on 2014 May 10]. Available from: http://www.cebm.net/index.aspx?o=1025 .

Higgins JP, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.

Egger M, Davey SG, Schneider M and Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997; 315:629-634.

Furyk JS, Chu K, Banks C, et al. Distal Ureteric Stones and Tamsulosin: A Double-Blind, Placebo-Controlled, Randomized, Multicenter Trial. Ann Emerg Med. 2016 Jan;67(1):86-95.

Vincendeau S, Bellissant E, Houlgatte A, et al. Tamsulosin Hydrochloride vs Placebo for Management of Distal Ureteral Stones. Arch Intern Med. 2010 Dec 13;170(22):2021-7.

Abdel-Meguid TA, Tayib A, Al-Sayyad A. Tamsulosin to treat uncomplicated distal ureteral calculi: a double blind randomized placebo-controlled trial. Can J Urol. 2010 Jun;17(3):5178-83.

Al-Ansari A, Al-Naimi A, Alobaidy A, et al. Efficacy of tamsulosin in the management of lower ureteral stones: a randomized double-blind placebo-controlled study of 100 patients. Urology. 2010 Jan;75(1):4-7.

Hermanns T, Sauermann P, Rufibach K, et al. Is There a Role for Tamsulosin in the Treatment of Distal Ureteral Stones of 7mm or Less? Results of a Randomised, Double-Blind, Placebo-Controlled Trial. Eur Urol. 2009 Sep;56(3):407-12.

Ochoa-Gómez R, Prieto-Díaz-Chávez E, Trujillo-Hernández B, et al. Tamsulosin does not have greater efficacy than conventional treatment for distal ureteral stone expulsion in Mexican patients. Urol Res. 2011 Dec;39(6):491-5.

Tiselius HG, Ackermann D, Alken P, Buck C, Conort P, Gallucci M. Guidelines on urolithiasis. Eur Urol 2001;40:362.

Cervenakov I, Fillo J, Mardiak J. Speedy elimination of ureterolithiasis in lower part of ureters with the alpha 1-blocker-tamsulosin. Int Urol Nephrol 2002; 34:25-9.

Hollingsworth JM, Rogers MA, Kaufman SR, et al. Medical therapy to facilitate urinary stone passage: a meta-analysis. Lancet 2006;368:1171-9.

Lu Z, Dong Z, Ding H, et al. Tamsulosin for ureteral stones: a systematic review and meta-analysis of a randomized controlled trial. Urol Int. 2012; 89(1):107-15.

Wang RC, Smith-Bindman R, Whitaker E, et al. Effect of Tamsulosin on Stone Passage for Ureteral Stones: A Systematic Review and Meta-analysis. Ann Emerg Med. 2017 Mar; 69(3):353-361.

Tzortzis V, Mamoulakis C, Rioja J, et al. Medical expulsive therapy for distal ureteral stones. Drugs 2009; 69: 677-92.

Seitz C, Liatsikos E, Porpiglia F, et al. Medical therapy to facilitate the passage of stones: What is the evidence? Eur Urol. 2009;56:455-471.

Phipps S, Tolley DA, Young JG, et al. The management of ureteric stones. Ann R Coll Surg Engl. 2010;92:368-372.

Chapple CR. A comparison of varying alpha-blockers and other pharmacotherapy options for lower urinary tract symptoms. Rev Urol 2005; 7 (Suppl 4): S22-30.




DOI: http://dx.doi.org/10.22037/uj.v0i0.4758

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