A network meta-analysis on the beneficial effect of medical expulsive therapy after extracorporeal shock wave lithotripsy

Yang, Tianen; Liao, Banghua; Chen, Yuntian; Li, Hong; He, Qiang; Liu, Qinyu; Wang, Kun‐Jie

doi:10.1038/s41598-017-14862-3

Cited by 8 publications

(4 citation statements)

References 42 publications

(40 reference statements)

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“…Medical expulsive therapy (MET) was used for promoting the spontaneous passage of stone fragment after ESWL and reducing the stone expulsion time and analgesic requirements (4)(5)(6). Nowadays, tamsulosin is the most common agents used in adjunctive MET after ESWL with large amount of relevant published studies (7). However, some randomized controlled trials (RCTs) showed conflicting results, especially for patients received ESWL for more than once.…”

Section: Introductionmentioning

confidence: 99%

Adjunctive medical expulsive therapy with tamsulosin for repeated extracorporeal shock wave lithotripsy: a systematic review and meta-analysis

et al. 2021

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Purpose: To evaluate the effi cacy of adjunctive medical expulsive therapy (MET) with tamsulosin for the promotion of stone fragments clearance for repeated extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: This meta-analysis was conducted by systematic search for randomized controlled trial (RCT) studies in PubMed/Medline, Scopus, Cochrane Library, Web of Science databases in January 2020, which compared tamsulosin with either placebo or non-placebo control for repeated ESWL. The primary endpoint was stonefree rate (SFR), the second endpoints were stone clearance time and complications. The quality assessment of included studies was performed by using the Cochrane System and Jadad score. Results: 7 RCTs were included in this meta-analysis. Tamsulosin provided higher SFR (for stones larger than 1cm, OR: 5.56, p=0.0003), except for patients with stones less than 1cm. For patients with renal stones (OR: 2.97, p=0.0005) or upper ureteral stones (OR: 3.10, p=0.004), tamsulosin can also provide a higher SFR. In addition, tamsulosin provided a shorter stone clearance time (WMD:-9.40, p=0.03) and lower pain intensity (WMD=-17.01, p <0.0001) and incidences of steinstrasse (OR: 0.37, p=0.0002). Conclusion: Adjunctive MET with tamsulosin is effective in patients with specifi c stone size or location that received repeated ESWL. However, no well-designed RCT that used computed tomography for the detection and assessment of residual stone fragments was found. More studies with high quality and the comparison between tamsulosin and secondary ESWL are needed in the future.

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Section: Introductionmentioning

confidence: 99%

Adjunctive medical expulsive therapy with tamsulosin for repeated extracorporeal shock wave lithotripsy: a systematic review and meta-analysis

et al. 2021

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“…To improve the results of SWL and obtain a better stone-free rate, many institutions have used medical expulsive therapy (MET) as an adjunctive treatment [ 7 ]. In the past few years, calcium channel blockers and alpha-1 adrenergic receptor antagonists have been the main established treatments of choice for MET [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of tamsulosin versus tamsulosin plus tadalafil on renal calculus clearance after shock wave lithotripsy: An open-labelled, randomised, prospective study

Neeli

2021

Asian Journal of Urology

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Objectives To compare the efficacy of tamsulosin versus tamsulosin plus tadalafil in achieving clearance of fragments after shock wave lithotripsy (SWL) to treat renal calculi. Methods Between January 2016 to December 2017, 140 patients with solitary, non-branched, non-lower calyceal renal calculus and measuring less than 20 mm and treated with SWL were randomized to tamsulosin (group A) or tamsulosin plus tadalafil (group B). Therapy was given for a period of 4 weeks. Stone clearance rate, analgesic requirement, occurrence of steinstrasse, need for auxiliary procedures (endoscopic treatment), and adverse effects of drugs were recorded. Results The overall clearance rate was 72.5% (50/69) in the group A and 90.1% (64/71) in the group B ( p =0.007). For stones up to 12 mm, the difference in the clearance rate was significant ( p =0.039) while it was not so for stones larger than 12 mm ( p =0.151). There was no statistically significant difference between the two groups with regards to analgesic requirement ( p =0.94), occurrence of steinstrasse ( p =0.101), need for auxiliary procedures ( p =0.76), and adverse effects of the drugs ( p =0.148). Conclusion Our study shows that adjunctive medical expulsive therapy with tamsulosin and tadalafil achieves better clearance rate than tadalafil alone in patients receiving SWL for renal stones.

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“…However, it does show superiority currently. For patients, timely use of extracorporeal shock wave lithotripsy and the selection of reasonable lithotropic drugs are particularly important for the radical treatment of kidney stone (Yang et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Increasing Nonsteroidal Anti-inflammatory Drugs and Reducing Opioids or Paracetamol in the Management of Acute Renal Colic: Based on Three-Stage Study Design of Network Meta-Analysis of Randomized Controlled Trials

Luo

Yao

et al. 2019

Front. Pharmacol.

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Background: Currently, although non-steroidal anti-inflammatory drugs (NSAIDs) were recommended for acute renal colic in the 2018 European Association of Urology guidelines, there are no specific NSAIDs and no specific routes of administration in this guideline. The clinical practice of advocating intravenous opioids as the initial analgesia is still common out of the fear of adverse events from NSAIDs. Objectives: To comprehensively assess the efficacy and safety of NSAIDs, opioids, paracetamol, and combination therapy for acute renal colic. Methods: Ovid MEDLINE, Ovid EMbase, the Cochrane Library, Clinical Trials Registry Platform for Clinicaltrials.gov, and WHO International Clinical Trials Registry Platform were searched through February 2, 2018. Two reviewers selected all randomized controlled trails (RCTs) regarding NSAIDs, opioids, paracetamol, combination therapy, and placebo were identified for analysis. We designed a three-stage strategy based on classification and pharmacological mechanisms in the first stage, routes of administration in the second stage, and specific drug branches with different routes in the third stage using network meta-analysis. The pain variance at 30 min was seen as the primary outcome. Results: 65 RCTs with 8633 participants were involved. Comparing different classification and pharmacological mechanisms, combination therapy with more adverse events was more efficient than NSAIDs for the primary outcomes. Opioids gave rise to more nonspecific adverse events and vomiting events. NSAIDs were superior to opioids, paracetamol, and combination therapy after a full consideration of all outcomes. Comparing different routes of administration, NSAIDs with IV or IM route ranked first from efficacy and safety perspective. Comparing different specific drug branches with different routes, ibuprofen via IV route, ketorolac via IV route and diclofenac via IM route were superior for the management of acute renal colic. The results from diclofenac using IM route were more than those from ibuprofen used with IV route and ketorolac with IV route. Conclusions: In patients with adequate renal function, diclofenac via the IM route is recommended for patients without risks of cardiovascular events. Ibuprofen and ketorolac with IV route potentially superior to diclofenac via IM route remain to be investigated. Combination therapy is an alternative choice for uncontrolled pain after the use of NSAIDs.

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A network meta-analysis on the beneficial effect of medical expulsive therapy after extracorporeal shock wave lithotripsy

Cited by 8 publications

References 42 publications

Adjunctive medical expulsive therapy with tamsulosin for repeated extracorporeal shock wave lithotripsy: a systematic review and meta-analysis

Adjunctive medical expulsive therapy with tamsulosin for repeated extracorporeal shock wave lithotripsy: a systematic review and meta-analysis

Effect of tamsulosin versus tamsulosin plus tadalafil on renal calculus clearance after shock wave lithotripsy: An open-labelled, randomised, prospective study

Increasing Nonsteroidal Anti-inflammatory Drugs and Reducing Opioids or Paracetamol in the Management of Acute Renal Colic: Based on Three-Stage Study Design of Network Meta-Analysis of Randomized Controlled Trials

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