Efficacy and Safety of Alfuzosin as Medical Expulsive Therapy for Ureteral Stones: A Systematic Review and Meta-Analysis

Abstract

BackgroundAlfuzosin has been widely used to treat benign prostatic hyperplasia and prostatitis, and is claimed to be a selective agent for the lower urinary tract with low incidence of adverse side-effects and hypotensive changes. Recently, several randomized controlled trials have reported using Alfuzosin as an expulsive therapy of ureteral stones. Tamsulosin, another alpha blocker, has also been used as an agent for the expulsive therapy for ureteral stones. It is unclear whether alfuzosin has similar efficacy as Tamsulosin in the management of ureteral stones.ObjectiveTo perform a systematic review and analysis of literatures comparing Alfuzosin with Tamsulosin or standard conservative therapy for the treatment of ureteral stones less than 10 mm in diameter.MethodsA systematic literature review was performed in December 2014 using Pubmed, Embase, and the Cochrane library databases to identify relevant studies. All randomized and controlled trials were included. A subgroup analysis was performed comparing Alfuzosin with control therapy on the management of distal ureteral stones.ResultsAlfuzosin provided a significantly higher stone-free rate than the control treatments (RR: 1.85; 95% confidence interval [CI], 1.35–2.55; p<0.001), and a shorter stone expulsion time (Weighted mean difference [WMD]: -4.20 d, 95%CI, -6.19 to -2.21; p<0.001), but it has a higher complication rate (RR: 2.02; 95% CI, 1.30–3.15; p<0.01). When Alfuzosin was compared to Tamsulosin, there was no significant difference in terms of stone-free rate (RR: 0.90; 95% CI, 0.79–1.02; p = 0.09) as well as the stone expulsion time (WMD: 0.52 d, 95%CI, -1.61 to 2.64; p = 0.63). The adverse effects of Alfuzosin were similar to those of Tamsulosin (RR: 0.88; 95% CI, 0.61–1.26; p = 0.47).ConclusionsAlfuzosin is a safe and effective agent for the expulsive therapy of ureteral stones smaller than 10 mm in size. It is more effective than therapeutic regiment without alpha blocker. It is equivalent to Tamsulosin in its effectiveness and safety profile. Adverse effects should always be kept in mind when use this class of drugs.

α‐blockers as medical expulsive therapy for ureteric stones: a Cochrane systematic review

“…Most of the earlier trials examining α‐blocker therapy for ureteric stones conclude that there is a higher stone clearance and faster stone expulsion time. From 2013 to 2015, multiple meta‐analyses were performed for different α‐blockers (tamsulosin , silodosin , and alfuzosin ) and those results were similar to those of the present review. In a meta‐analysis from 2016 by Hollingsworth et al.…”

Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis

“…1 2 This endorsement is based on several systematic reviews and meta-analyses of numerous randomized controlled trials, which, in aggregate, showed a higher risk of stone passage among patients treated with alpha blockers (their use has been termed medical expulsive therapy) compared with controls. [3][4][5][6][7][8][9] Consequently, such treatment has become part of the routine management algorithm for ureteric colic.…”

The evaluation of the effectiveness of Gilaburu (Viburnum opulus L.) extract in the medical expulsive treatment of distal ureteral stones

“…[12] In many meta-analyses published between 2013 and 2015, it was reported that the rate of stone clearance increased with different alpha-blockers (tamsulosin, silodosin, and alfuzosin), and the expulsion time accelerated. [21,22] However, alpha-blockers have also been shown to increase the risk of major side effects according to the subgroup analysis of placebo-controlled trials and main analysis. [6] On the other hand, a randomized clinical trial suggesting that tamsulosin did not increase passage for ureteral located stones <9 mm was recently published.…”