Tamsulosin as adjunctive treatment after shockwave lithotripsy in patients with upper urinary tract stones: A systematic review and meta-analysis

Zheng, Shuo; Liu, Liang Ren; Yuan, Hai Chao; Wang, Qiang

doi:10.3109/00365599.2010.523014

Cited by 41 publications

(25 citation statements)

References 26 publications

(41 reference statements)

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“…Most of the factors affecting the migration process, such as ureteral spasm, peristalsis, edema and infection [16], can be modified by the appropriate medical therapies. Various medications such as calcium channel blockers, corticosteroid agents and alpha-1 AR blockers have been investigated to improve upper urinary stone clearance by acting primarily on ureteral edema and spasm [17,18,19]. …”

Section: Discussionmentioning

confidence: 99%

Role of Tamsulosin Therapy after Extracorporeal Shockwave Lithotripsy for Renal Stones: Randomized Controlled Trial

Ahmed

Shalaby²,

El-Feky³

et al. 2016

Urol Int

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Introduction: To evaluate the efficacy of adjunctive tamsulosin therapy after extracorporeal shockwave lithotripsy (SWL) for renal stones. Materials and Methods: This prospective study was conducted on patients who underwent single-session SWL for solitary renal stone less than 20 mm. Post-SWL, patients were randomly divided into 2 groups; the tamsulosin group (TG), received a daily dose of tamsulosin 0.4 mg, for a maximum of 12 weeks, with post-SWL traditional analgesia and control group (CG), received the traditional analgesia alone. Results: The study enrolled 271 patients and eventually only 249 (123 in TG and 126 in CG) completed the study. The overall stone free rate was 73.5%: 78.0% in TG and 69.0% in CG (p = 0.108). In TG, 8.1% of patients experienced at least one episode of acute renal/ureteral colic compared with 19.8% of controls (p = 0.008). The mean cumulative analgesia dosage per subject was 313 mg in TG and 346 mg in CG (p < 0.001). Overall, 14 patients developed steinstrasse and 6 of them (all in CG) needed urgent intervention (p = 0.031). Conclusions: Daily tamsulosin therapy does not enhance the clearance of stone fragments but decreases the pain episodes, analgesia dosage and need for adjuvant intervention after SWL for renal stones.

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Section: Discussionmentioning

confidence: 99%

Role of Tamsulosin Therapy after Extracorporeal Shockwave Lithotripsy for Renal Stones: Randomized Controlled Trial

Ahmed

Shalaby²,

El-Feky³

et al. 2016

Urol Int

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“…Various agents have been investigated including calcium channel blockers, alpha-adrenergic antagonists, corticosteroids and smooth muscle relaxants [4,5]. The goal of medical therapy is to enhance stone expulsion with a parallel decrease in the associated pain.…”

Section: Introductionmentioning

confidence: 99%

Tamsulosin and doxazosin as adjunctive therapy following shock-wave lithotripsy of renal calculi: randomized controlled trial

et al. 2011

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Alpha-blockers have been established as medical expulsive therapy for urolithiasis. We aimed to assess the effect of tamsulosin and doxazosin as adjunctive therapy following SWL for renal calculi. We prospectively included 150 patients who underwent up to four SWL sessions for renal stones from June 2008 to 2009. Patients were randomized into three groups of 50 patients each, group A (phloroglucinol 240 mg daily), group B (tamsulosin 0.4 mg once daily plus phloroglucinol), and group C (doxazosin 4 mg plus phloroglucinol). The treatment continued up to maximum 12 weeks. Patients were evaluated for stone expulsion, colic attacks, amount of analgesics and side-effects of alpha-blockers. There were no significant differences between the groups regarding stone expulsion rates (84; 92 and 90%, respectively). The mean expulsion time of tamsulosin was significantly shorter than both control group (p = 0.002) and doxazosin (p = 0.026). Both number of colic episodes and analgesic dosage were significantly lower with tamsulosin as compared to control and doxazosin. Steinstrasse was encountered in 10 (6.7%) patients with no significant difference between the groups. 16 patients on tamsulosin and 21 on doxazosin experienced adverse effects related to postural hypotension. Moreover, 2 (4%) patients in the tamsulosin group reported ejaculatory complaints. In conclusion, adjunction of tamsulosin or doxazosin after SWL for renal calculi decreases the time for stone expulsion, amount of the analgesics and number colic episodes. There was no benefit regarding the overall stone expulsion rate. The side-effects of these agents are common and should be weighted against the benefits of their usage.

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“…After observing such positive effects, in recent years, physicians have started to apply MET in an attempt to facilitate the spontaneous passage of the stone fragments and increase stone free rates after shock wave application. They also aimed at decreasing the rate of complications and need for additional invasive interventions, which will eventually decrease the healthcare costs [25]. Regarding this subject; in their well-prepared meta-analytic study, Zhu et al [26] reported that the pooled absolute risk difference of the stone clearance rate was 16% (95% CI 5-27) and the pooled mean difference of the expulsion time was 8 days (95% CI -3 to 20) in favor of the tamsulosin medication.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding this subject; in their well-prepared meta-analytic study, Zhu et al [26] reported that the pooled absolute risk difference of the stone clearance rate was 16% (95% CI 5-27) and the pooled mean difference of the expulsion time was 8 days (95% CI -3 to 20) in favor of the tamsulosin medication. In another meta-analysis performed by Zheng et al [25,] tamsulosin was found to be effective enough for stone clearance (RR 1.24; 95% CI 1.12-1.37) with shortened expulsion time (mean difference -0.34; 95% CI -0.56 to 0.11) compared to that of the control group. Additionally, lower analgesic requirement, fewer colic episodes as well as adverse effects were demonstrated.…”

Section: Discussionmentioning

confidence: 99%

Medical Expulsive Therapy Following Shock Wave Lithotripsy in Ureteral Calculi: An Effective Approach for the Improvement of Health-Related Quality of Life

Eryıldırım¹,

Şahin²,

Tuncer³

et al. 2016

Urol Int

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Objective: To evaluate the possible effects of medical expulsive therapy (MET) on the health-related quality of life (HRQOL) of patients undergoing shock wave lithotripsy (SWL) for ureteric stones. Methods: Eighty patients treated with SWL for ureteric stones were included in this study. Patients were divided into 2 groups; Group 1 received medical therapy only for colic pain and Group 2 received MET in addition to medical therapy. Patients requiring DJ stenting and auxiliary measures after SWL procedure were excluded. The remaining 54 patients were further evaluated (Group 1: n = 26, Group 2: n = 28) and followed up during the 4-week period for analgesic requirement, number of renal colic attacks, emergency department (ED) visits and the HRQOL scores by using EQ-5D index and EQ-5D visual analogue scale (VAS) values. Results: During the 4-week follow-up period, cases undergoing SWL only required significantly higher amount of analgesics. In addition to the lower number of renal colic attacks and ED visits, EQ-5D index and EQ-5D VAS values also demonstrated higher mean values in patients undergoing SWL + MET. Conclusion: In addition to the increased spontaneous stone passage rates, MET following SWL for ureteral calculi could increase the HRQOL scores by lowering the number of both renal colic attacks and ED visits along with decreased analgesic need.

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Tamsulosin as adjunctive treatment after shockwave lithotripsy in patients with upper urinary tract stones: A systematic review and meta-analysis

Abstract: Tamsulosin is a safe and effective therapy for renal and ureteral stones after SWL. Further, high-quality randomized trials are necessary to confirm its efficacy.

Cited by 41 publications

References 26 publications

Role of Tamsulosin Therapy after Extracorporeal Shockwave Lithotripsy for Renal Stones: Randomized Controlled Trial

Role of Tamsulosin Therapy after Extracorporeal Shockwave Lithotripsy for Renal Stones: Randomized Controlled Trial

Tamsulosin and doxazosin as adjunctive therapy following shock-wave lithotripsy of renal calculi: randomized controlled trial

Medical Expulsive Therapy Following Shock Wave Lithotripsy in Ureteral Calculi: An Effective Approach for the Improvement of Health-Related Quality of Life

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