Distal Ureteric Stones and Tamsulosin: A Double-Blind, Placebo-Controlled, Randomized, Multicenter Trial

Furyk, Jeremy; Chu, Kevin; Banks, Colin; Greenslade, Jaimi; Keijzers, Gerben; Thom, Ogilvie; Torpie, Tom; Dux, Carl; Narula, Rajan

doi:10.1016/j.annemergmed.2015.06.001

Cited by 120 publications

(124 citation statements)

References 27 publications

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“…Because tamsulosin was the most commonly used to promote ureteral stones expulsion, we made a comparison Silodosin with tamsulosin. [28][29][30] The results demonstrated that compared with tamsulosin, there was a 20% improvement of stone clearance in Silodosin group. For expulsion time, compared to control, other alpha-blockers could shorten 2.91 days and Silodosin could shorten 4.5 days.…”

Section: Discussionmentioning

confidence: 66%

The role of Silodosin as a new medical expulsive therapy for ureteral stones: a meta-analysis

et al. 2016

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To evaluate the efficacy of Silodosin as a medical expulsive therapy of ureteral stones, we searched PubMed, EMBASE, the Cochrane Library, and CBM up to June 2015. All randomized controlled trials (RCTs) were identified in which patients were randomized to receive Silodosin versus placebo or other therapies for ureteral stones. Outcome measures assessed were overall stone expulsion rate (primary) and expulsion time, analgesics times, and the incidence of additional treatment and regarding treatment complications (secondary). Two authors independently assessed study quality and extracted data. All data were analyzed using RevMan 5.3. Seven RCTs with a total of 1035 patients met the inclusion criteria. The pooled meta-analysis showed a significant improvement in stone clearance with Silodosin (Silodosin versus placebo, OR ¼1.69, 95% CI [1.19-2.40], p ¼ 0.003; Silodosin versus tamsulosin, OR ¼2.82, 95% CI [1.79-4.44], p < 0.00001). According to the size and location of ureteral stone, the pooling effects of Silodosin were analyzed, with a meaningful expulsion rate in distal ureteral stone when the size was 5-10 mm. In addition, a shorter expulsion time, fewer analgesics times, and additional treatments were observed. The common side effect was retrograde ejaculation. In summary, Silodosin appears to be more effective than either placebo or tamsulosin. Within the limits of available data, highquality multicenter RCTs are needed to thoroughly evaluate the outcome in the future. ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 66%

The role of Silodosin as a new medical expulsive therapy for ureteral stones: a meta-analysis

et al. 2016

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“…However, the data from several recent well-planned randomized clinical trials did not shown the MET benefits in patients with ureteric stones [19,20].…”

Section: Discussion Of Results Of the Studymentioning

confidence: 99%

Possibilities to Improve the Therapy of the Patients With Ureteral Concretions

Сабадаш

Shulyak

Chabanov

2017

EUREKA: Health Sciences

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The aim of the given study was to improve the results of treatment of patients with concretions of the upper third of the ureter. Materials and methods. The clinical trial was carried out as a non-interventional open, controlled, in two groups of patients with baseline control. The inclusion criteria concerned the patients with concretions of the upper third of the ureter 0.7-0.9 mm in size, which had one session of an extracorporeal shock-wave lithotripsy (ESWL), and after the procedure the size of the concretions fragments was up to3 mm. The study involved 60 patients, all patients in the main group (n = 30) were treated using phytotherapy, within 1 month starting with basic therapy under hospital conditions and continuing with preventative treatment in an outpatient setting. The control group (n = 30) received baseline therapy (up to 10 days) at the stationary stage. Results and discussion. In patients of the main group, fragments of concretions came out significantly faster, namely: in the main group, the fragments came out in 21 patients (70.0 %), while in the control group in 15 patients (50.0 %) (p1- p2, p <0.05) to the 7th day, and in the main group, the fragments came out in one patient more than 14 days, and in the control group – in 5 patients, p <0.05. The "stone path" in the bottom third of the ureter was in 1 patient (3.3 %) of the main group and in 3 patients (10.0 %) in the control group (p1-p2, p <0.05). The "stone path" departure time in patients of the main group was 2 days, and in patients of the control group it was 4.1 days from the time of its formation (p1-p2, p <0.05). Bacteriuria was observed in the main group on the 10th day 6.6 % less relative to the control group. Conclusion. At comparing the obtained results in patients of both groups in 1 month it was noted that high efficacy of the treatment was registered in 6 (20 %) patients of the main group and in 3 patients (10 %) of the control group (p <0.05), moderate efficiency was registered in 23 (76.7 %) patients of the main group and in 22 (73.3 %) patients of the control group respectively, low efficacy was registered in 1 (3.33 %) patient in the main group and 5 (16.7 %) patients of the control group (p <0,05), which points to the effectiveness of Urolesan capsules use in complex therapy of patients with concretions of the one third of ureter.

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“…6,9,15 Furthermore, a recently published trial suggested that patients with large stones (5 to 10 mm) benefited from tamsulosin, whereas those with smaller stones (<5mm) did not. 9 We hypothesized that stone size modified the effect of tamsulosin and accounted for between-study heterogeneity, or could help resolve discrepancies between "negativeresult" multicenter trials and previous meta-analyses. 16 Thus, we sought to conduct a prespecified analysis comparing the effect of tamsulosin in a small-stone (<5 mm) versus large-stone (5 to 10 mm) subgroup.…”

Section: Data Collection and Processing And Primary Data Analysismentioning

confidence: 99%

“…We also conducted a subgroup analysis (stone size <5 versus 5 to 10 mm) to determine whether stone size modifies the effect of tamsulosin, as suggested by the latest trial. 9 This study will clarify the role of tamsulosin in patients receiving a diagnosis of ureteral stones less than 10 mm that do not require urgent intervention.…”

Section: Goals Of This Investigationmentioning

confidence: 99%

“…Two subsequent multicenter randomized placebo-controlled trials did not show a significant benefit of tamsulosin, except in the most recent randomized trial, which suggested a benefit in a subgroup with larger stones (5 to 10 mm). 8,9 These conflicting results have led to considerable uncertainty in regard to the efficacy of tamsulosin for increasing the passage of ureteral stones.…”

Section: Introduction Backgroundmentioning

confidence: 99%

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Effect of Tamsulosin on Stone Passage for Ureteral Stones: A Systematic Review and Meta-analysis

Wang

Smith‐Bindman

Whitaker

et al. 2017

Annals of Emergency Medicine

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Twitter: @ralphcwang.Study objective: Tamsulosin is recommended for patients receiving a diagnosis of a ureteral stone less than 10 mm who do not require immediate urologic intervention. Because of conflicting results from recent meta-analyses and large randomized controlled trials, the efficacy of tamsulosin is unclear. We perform a systematic review and meta-analysis to investigate the effect of tamsulosin on stone passage in patients receiving a diagnosis of ureteral stone.Methods: MEDLINE, EMBASE, and CENTRAL databases were searched without language restriction through November 2015 for studies assessing the efficacy of tamsulosin and using a double-blind, randomized, controlled trial design. Meta-analysis was conducted with a random-effects model and subgroup analyses were conducted to determine sources of heterogeneity.Results: Eight randomized controlled trials (N¼1,384) contained sufficient information for inclusion. The pooled risk of stone passage in the tamsulosin arm was 85% versus 66% in the placebo arm, but substantial heterogeneity existed across trials (I 2 ¼80.2%; P<.001). After stratifying of studies by stone size, the meta-analysis of the large stone subgroup (5 to 10 mm; N¼514) indicated a benefit of tamsulosin (risk difference¼22%; 95% confidence interval 12% to 33%; number needed to treat¼5). The meta-analysis of the small stone subgroup (<4 to 5 mm; N¼533) indicated no benefit (risk difference¼-0.3%; 95% confidence interval -4% to 3%). Neither meta-analysis for the occurrence of dizziness or hypotension showed a significant effect. Conclusion:Tamsulosin significantly improves stone passage in patients with larger stones, whereas the effect of tamsulosin is diminished in those with smaller stones, who are likely to pass their stone regardless of treatment.

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Distal Ureteric Stones and Tamsulosin: A Double-Blind, Placebo-Controlled, Randomized, Multicenter Trial

Cited by 120 publications

References 27 publications

The role of Silodosin as a new medical expulsive therapy for ureteral stones: a meta-analysis

The role of Silodosin as a new medical expulsive therapy for ureteral stones: a meta-analysis

Possibilities to Improve the Therapy of the Patients With Ureteral Concretions

Effect of Tamsulosin on Stone Passage for Ureteral Stones: A Systematic Review and Meta-analysis

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