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

Abstract

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.

Efficacy of tamsulosin versus tadalafil as medical expulsive therapy on stone expulsion in patients with distal ureteral stones: A randomized double-blind clinical trial

“…Although many studies reported that tadalafil is more effective than tamsulosin in facilitating stone expulsion (20)(21)(22)(23), in the current study, the rate of stone expulsion in the tamsulosin group was higher than tadalafil and placebo groups (72.7%, 63.6% and 56.8%, respectively). However, this difference did not reach statistical significance (P=0.294).…”

“…Alpha-blockers, calcium channel blockers (CCB), and PDE5-Is in MET have been used to improve stone passage and decrease the need for analgesics (17). The role of adjunctive MET with tamsulosin on ureteral stone expulsion has been reported (22).…”

The effects of pregabalin, solifenacin and their combination therapy on ureteral double-J stent-related symptoms: A randomized controlled clinical trial

“…There are many different procedures to treatment ureteral stones. Adjunctive medical expulsive therapy (MET) with tamsulosin had an important role to pass ureteral stones (14).…”

Canadian Urological Association guideline: Management of ureteral calculi – Abridged version

“…Alpha-blockers (most commonly tamsulosin) have been studied to assess their impact on SWL outcomes in multiple RCTs and meta-analyses. [86][87][88][89][90][91][92][93][94][95] Meta-analyses have shown improved SWL success rates, 89,[94][95][96] time to stone passage, risk of steinstrasse, [93][94][95][96] and need for auxiliary procedures. 93 A recently published Cochrane systematic review demonstrated routine alpha-blocker therapy may result in improved stone clearance, less need for auxiliary treatments, fewer major adverse events, and a reduced stone clearance time.…”