Tamsulosin as a Medical Expulsive Therapy for Ureteral Stones: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

No AccessJournal of UrologyAdult Urology1 May 2019Tamsulosin as a Medical Expulsive Therapy for Ureteral Stones: A Systematic Review and Meta-Analysis of Randomized Controlled TrialsThis article is commented on by the following:Editorial CommentEditorial Comment Yu Cui, Jinbo Chen, Feng Zeng, Peihua Liu, Jiao Hu, Huihuang Li, Chao Li, Xu Cheng, Minfeng Chen, Yangle Li, Yang Li, Zhongqing Yang, Zhiyong Chen, Harripersaud Chand, Hequn Chen, and Xiongbing Zu Yu CuiYu Cui Department of Urology, Xiangya Hospital, Central South University, Changsha, China Equal study contribution. More articles by this author , Jinbo ChenJinbo Chen Department of Urology, Xiangya Hospital, Central South University, Changsha, China Equal study contribution. More articles by this author , Feng ZengFeng Zeng Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author , Peihua LiuPeihua Liu Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author , Jiao HuJiao Hu Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author , Huihuang LiHuihuang Li Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author , Chao LiChao Li Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author , Xu ChengXu Cheng Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author , Minfeng ChenMinfeng Chen Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author , Yangle LiYangle Li Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author , Yang LiYang Li Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author , Zhongqing YangZhongqing Yang Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author , Zhiyong ChenZhiyong Chen Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author , Harripersaud ChandHarripersaud Chand Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author , Hequn ChenHequn Chen †Correspondence: Department of Urology, Xiangya Hospital, Central South University, Changsha410008, China (telephone: +86-731-8975-3011; FAX: +86-731-8975-3280; e-mail: E-mail Address: [email protected], E-mail Address: [email protected]). Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author , and Xiongbing ZuXiongbing Zu †Correspondence: Department of Urology, Xiangya Hospital, Central South University, Changsha410008, China (telephone: +86-731-8975-3011; FAX: +86-731-8975-3280; e-mail: E-mail Address: [email protected], E-mail Address: [email protected]). Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000029AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Tamsulosin is widely administered as a medical expulsive therapy to facilitate stone passage in patients with ureteral calculi. Recently several large, multicenter, randomized controlled trials revealed conflicting results, which led to considerable uncertainty about the efficacy of tamsulosin in the management of ureteral stones. The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of tamsulosin in the management of ureteral stones. Materials and Methods: We searched MEDLINE®, Embase®, Web of Knowledge, Google Scholar™ and the Cochrane Central Search Library databases up to June 2018. Two reviewers independently evaluated eligible randomized controlled trials of the efficacy of tamsulosin to treat ureteral stones. Study quality was assessed with the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. Subgroup analyses were performed to explore heterogeneity. Results: Included in study were 56 randomized controlled trials in a total of 9,395 patients. The observed treatment effect indicated that tamsulosin was associated with a higher stone expulsion rate (RR 1.44, 95% CI 1.35-1.55, p <0.01), a shorter stone expulsion time (weighted mean difference –0.73, 95% CI –1.00-–0.45, p <0.01), a lesser incidence of ureteral colic (weighted mean difference –0.81, 95% CI –1.24-–0.39, p <0.01) and fewer incidences of requiring subsequent intervention (RR 0.68, 95% CI 0.50-0.93, p = 0.017). Treatment with tamsulosin did not differ from a control group in the overall incidence of side effects (RR 1.14, 95% CI 0.86-1.51, p = 0.36). On subgroup analysis we observed a significant benefit in the stone expulsion rate for tamsulosin among patients with stones greater than 5 mm (RR 1.44, 95% CI 1.22-1.68, p <0.01) but no effect for stones 5 mm or less (RR 1.08, 95% CI 0.99-1.68, p <0.01). Conclusions: Our current meta-analysis results indicate that tamsulosin is effective and relatively safe in patients with ureteral stone as a medical expulsive therapy to facilitate stone passage. It is suggested to administer it selectively in patients with 5 to 10 mm ureteral stones. References 1. : EAU guidelines on diagnosis and conservative management of urolithiasis. Eur Urol 2016; 69: 468. Google Scholar 2. : Trends in urological stone disease. BJU Int 2012; 109: 1082. Google Scholar 3. : The economics of stone disease. World J Urol 2017; 35: 1321. Google Scholar 4. : Cost-effectiveness of medical expulsive therapy using alpha-blockers for the treatment of distal ureteral stones. Eur Urol 2008; 53: 411. Google Scholar 5. : 2007 Guideline for the management of ureteral calculi. J Urol 2007; 178: 2418. Link, Google Scholar 6. : Tamsulosin for ureteral stones: a systematic review and meta-analysis of a randomized controlled trial. Urol Int 2012; 89: 107. 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Google Scholar Supported Natural Science Foundation of China Grant 81572523, Hunan Province Funds for Distinguished Young Scientists of China Grant 2016JJ1026, the Key Research and Development Project of Hunan Provincial Science and Technology Department Grant 2016JC2041 and Fundamental Research Funds for the Central Universities of Central South University Grant 2016zzts121. © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byHall M, Thiel J, Dunmire B, Samson P, Kessler R, Sunaryo P, Sweet R, Metzler I, Chang H, Gunn M, Dighe M, Anderson L, Popchoi C, Managuli R, Cunitz B, Burke B, Ding L, Gutierrez B, Liu Z, Sorensen M, Wessells H, Bailey M and Harper J (2022) First Series Using Ultrasonic Propulsion and Burst Wave Lithotripsy to Treat Ureteral StonesJournal of Urology, VOL. 208, NO. 5, (1075-1082), Online publication date: 1-Nov-2022.Stensland K, Malinconico L and Canes D (2019) Tamsulosin and Distal Ureteral Stones—How Much Evidence is Enough? Exploring Value of Information in UrologyJournal of Urology, VOL. 202, NO. 3, (465-466), Online publication date: 1-Sep-2019.Related articlesJournal of Urology8 Apr 2019Editorial CommentJournal of Urology8 Apr 2019Editorial Comment Volume 201Issue 5May 2019Page: 950-955Supplementary Materials Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.KeywordsChinaureteral calculiurolithiasistamsulosindrug therapyMetricsAuthor Information Yu Cui Department of Urology, Xiangya Hospital, Central South University, Changsha, China Equal study contribution. More articles by this author Jinbo Chen Department of Urology, Xiangya Hospital, Central South University, Changsha, China Equal study contribution. More articles by this author Feng Zeng Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author Peihua Liu Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author Jiao Hu Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author Huihuang Li Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author Chao Li Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author Xu Cheng Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author Minfeng Chen Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author Yangle Li Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author Yang Li Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author Zhongqing Yang Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author Zhiyong Chen Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author Harripersaud Chand Department of Urology, Xiangya Hospital, Central South University, Changsha, China More articles by this author Hequn Chen Department of Urology, Xiangya Hospital, Central South University, Changsha, China †Correspondence: Department of Urology, Xiangya Hospital, Central South University, Changsha410008, China (telephone: +86-731-8975-3011; FAX: +86-731-8975-3280; e-mail: E-mail Address: [email protected], E-mail Address: [email protected]). More articles by this author Xiongbing Zu Department of Urology, Xiangya Hospital, Central South University, Changsha, China †Correspondence: Department of Urology, Xiangya Hospital, Central South University, Changsha410008, China (telephone: +86-731-8975-3011; FAX: +86-731-8975-3280; e-mail: E-mail Address: [email protected], E-mail Address: [email protected]). More articles by this author Expand All Supported Natural Science Foundation of China Grant 81572523, Hunan Province Funds for Distinguished Young Scientists of China Grant 2016JJ1026, the Key Research and Development Project of Hunan Provincial Science and Technology Department Grant 2016JC2041 and Fundamental Research Funds for the Central Universities of Central South University Grant 2016zzts121. Advertisement PDF downloadLoading ...