A network meta-analysis on the beneficial effect of medical expulsive therapy after extracorporeal shock wave lithotripsy

Tong-Xin Yang,Kun-Jie Wang,Hong Li,Qin-Yu Liu,Yun-Tian Chen,Qing He,Bang-Hua Liao

doi:10.1038/s41598-017-14862-3

Tong-Xin Yang, Kun-Jie Wang + Show 5 more

Open Access

https://doi.org/10.1038/s41598-017-14862-3

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Abstract

We applied a newly introduced method, network meta-analysis, to re-evaluate the expulsion effect of drugs including tamsulosin, doxazosin, nifedipine, terazosin and rowatinex after extracorporeal shock wave lithotripsy (ESWL) as described in the literature. A systematic search was performed in Medline, Embase and Cochrane Library for articles published before March 2016. Twenty-six studies with 2775 patients were included. The primary outcome was the number of patients with successful stone expulsion. The data were subdivided into three groups according to duration of follow-up. A standard network model was established in each subgroup. In 15-day follow-up results, SUCRA outcome showed the ranking of effects was: doxazosin > tamsulosin > rowatinex > nifedipine > terazosin (88.6, 77.4, 58.6, 32.2 and 30.4, respectively). In 45-day follow-up results, SUCRA ranking was: tamsulosin > nifedipine > rowatinex (69.4, 67.2 and 62.6, respectively). In 90-day follow-up results, SUCRA ranking was: doxazosin > rowatinex > tamsulosin (84.1, 68.1 and 49.1, respectively). In conclusion, doxazosin and tamsulosin have potential to be the first choice for pharmacological therapy to promote the expulsion of urinary stone fragments after ESWL, with this doxazosin can improve the SFR in the long term, while tamsulosin may result more in accelerating the process of expulsion.

Highlights

Extracorporeal shock wave lithotripsy (ESWL) represents an effective minimally invasive treatment for renal and ureteral stones greater than 5 mm in size[1]
One randomized controlled trials (RCTs) can precisely resolve the issue of whether a medication can improve the stone-free rate (SFR) compared with a placebo or watchful waiting after a certain period, but cannot provide a wide view of its expulsion effect throughout the therapeutic process, and cannot reveal the difference between medications either
The current study demonstrated that doxazosin had a higher surface under the cumulative ranking (SUCRA) score than tamsulosin for improving SFR after extracorporeal shock wave lithotripsy (ESWL)

Summary

Introduction

Extracorporeal shock wave lithotripsy (ESWL) represents an effective minimally invasive treatment for renal and ureteral stones greater than 5 mm in size[1]. One RCT can precisely resolve the issue of whether a medication can improve the SFR compared with a placebo or watchful waiting after a certain period, but cannot provide a wide view of its expulsion effect throughout the therapeutic process, and cannot reveal the difference between medications either. In this context, network meta-analysis is a useful method in which multiple treatments can be directly or indirectly compared even if they are not designed in the same RCT, but have the same control group[34,35]. We subdivided the available data according to follow-up duration, and compared whether there were differences between those medications throughout the period of stone expulsion

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Conclusion