Abstract
ABSTRACTPurpose:To evaluate the efficacy of adjunctive medical expulsive therapy (MET) with tamsulosin for the promotion of stone fragments clearance for repeated extracorporeal shock wave lithotripsy (ESWL).Materials and Methods:This meta-analysis was conducted by systematic search for randomized controlled trial (RCT) studies in PubMed/Medline, Scopus, Cochrane Library, Web of Science databases in January 2020, which compared tamsulosin with either placebo or non-placebo control for repeated ESWL. The primary endpoint was stone-free rate (SFR), the second endpoints were stone clearance time and complications. The quality assessment of included studies was performed by using the Cochrane System and Jadad score.Results:7 RCTs were included in this meta-analysis. Tamsulosin provided higher SFR (for stones larger than 1cm, OR: 5.56, p=0.0003), except for patients with stones less than 1cm. For patients with renal stones (OR: 2.97, p=0.0005) or upper ureteral stones (OR: 3.10, p=0.004), tamsulosin can also provide a higher SFR. In addition, tamsulosin provided a shorter stone clearance time (WMD: −9.40, p=0.03) and lower pain intensity (WMD=-17.01, p <0.0001) and incidences of steinstrasse (OR: 0.37, p=0.0002).Conclusion:Adjunctive MET with tamsulosin is effective in patients with specific stone size or location that received repeated ESWL. However, no well-designed RCT that used computed tomography for the detection and assessment of residual stone fragments was found. More studies with high quality and the comparison between tamsulosin and secondary ESWL are needed in the future.
Highlights
Urolithiasis is a very common disease in the World with prevalence rates varying from 1% to 20% [1]
We conducted this systematic review and meta-analysis of evidence from randomized controlled trial (RCT) to evaluate the efficacy of adjunctive Medical expulsive therapy (MET) with tamsulosin for repeated extracorporeal shock wave lithotripsy (ESWL), primarily in the terms of stone-free rates (SFR), stone clearance time and complications
Data sources and literature search This meta-analysis was conducted through comprehensive research of PubMed/Medline, Scopus, Cochrane Library, Web of Science databases with the search terms of “(medical expulsive therapy or upper ureteral stones (OR) tamsulosin) AND AND” before January 2020 according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement [8]
Summary
Urolithiasis is a very common disease in the World with prevalence rates varying from 1% to 20% [1]. The success of ESWL is not satisfactory enough. It depends on the types of lithotripter, stones characteristics and geographic regions [3]. Medical expulsive therapy (MET) was used for promoting the spontaneous passage of stone fragment after ESWL and reducing the stone expulsion time and analgesic requirements [4,5,6]. Tamsulosin is the most common agents used in adjunctive MET after ESWL with large amount of relevant published studies [7]. We conducted this systematic review and meta-analysis of evidence from RCTs to evaluate the efficacy of adjunctive MET with tamsulosin for repeated ESWL, primarily in the terms of stone-free rates (SFR), stone clearance time and complications
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