α‐Blockers to assist stone clearance after extracorporeal shock wave lithotripsy: a meta‐analysis

Abstract

Study Type – Therapy (meta‐analysis) Level of Evidence 1a OBJECTIVE To review the evidence for the use of α‐blockers after extracorporeal shock wave lithotripsy (ESWL) in enhancing the effectiveness of renal and ureteric stone clearance. METHODS We searched MEDLINE, Embase and the Cochrane Library up to January 2009. All randomized controlled trials in which α‐blockers were evaluated after ESWL were eligible for the analysis. Outcome measures assessed were clearance rate (primary) and expulsion time (secondary). Two authors independently assessed study quality and extracted data. All data were analysed using RevMan 5. RESULTS Of the 29 identified papers, seven trials with a total of 484 patients met the predefined criteria. These studies evaluated the effectiveness of the α‐blocker tamsulosin, and studied clearance rate as the primary outcome. There was large heterogeneity between trials, but their methodological quality was adequate. The pooled absolute risk difference of clearance rate was 16% (95% confidence interval 5–27%) in favour of the tamsulosin group, i.e. an average of six patients have to be treated with tamsulosin after ESWL to achieve clearance in one. Subgroup analysis for the six studies that used a dose of 0.4 mg tamsulosin showed a pooled risk difference of 19 (10–29)%. The expulsion time was analysed in three studies and the pooled mean difference was 8 (−3–20) days in favour of the tamsulosin group. Pain and analgesic usage was reported to be lower with tamsulosin. Adverse effects of tamsulosin, mainly dizziness, were reported in eight patients (3%). CONCLUSIONS Treatment with tamsulosin after ESWL appears to be effective in assisting stone clearance in patients with renal and ureteric calculi. To make a definite clinical recommendation to use tamsulosin after ESWL for renal and ureteric calculi, a high quality confirmatory trial is warranted.

CUA Guideline: Management of ureteral calculi

“…The authors identified seven trials that met the inclusion criteria and found that the use of alpha-blockers, which was tamsulosin in all seven studies, improved SWL success by 16%. 47,[51][52][53][54][55][56][57] The authors also reported reduced time to fragment passage, reduced pain, and required less analgesia.…”

Lower Ureteric Stones Expulsion; Comparison of Tamsulosin Versus Extracorporeal Shock Wave Lithotripsy (Eswl)

“…22 Various studies and practical's done for checking the efficacy of tamsulosin it was observed that mean expulsion time of tamsulosin was about 15 days. 23 Choi et al, conducted a study that alpha blocker post lithotripsy showed excellent results than calcium channel blocker post ithotripsy. 24 Kim et al 25 documented results between alpha blocker and control groups.…”

Evaluation of the efficacy of tamsulosin with or without deflazacort for stone clearance after extracorporeal shockwave lithotripsy for upper ureteral and renal calculi

“…Similarly Zhu Y, et al in a meta analysis concluded that treatment with tamsulosin after ESWL appears to be effective in assisting stone clearance in patients with renal and ureteral calculi. 11 All these above mentioned studies have used tamsulosin alone as an adjunctive procedure to ESWL and have found it to be effecticve. In our experience addition of deflazacort, a low dose steroid, will significantly improve the ESWL outcomes.…”