Abstract
BackgroundLower ureteric stones and lower urinary tract symptoms are common in urology.Drug treatment is one of standard therapy,but the efficacy was controversial.Thus we aimed to investigate the efficacy and safety of monotherapy or combination therapy of adrenoceptor1 blockers and phosphodiesterase5 inhibitors for treatment.MethodsRandomized controlled trials up to November 2016 were retrieved from PubMed, the Cochrane Library, Web of Science and Embase. A total of 17 studies were included. We analyzed data through random or fixed effect models. The heterogeneity between studies was assessed by the I2 test statistic.ResultsAs for lower ureter stones, our analysis demonstrated tadalafil had a significantly lower incidence of abnormal ejaculation than adrenoceptor1 blockers (2.31 95%CI 0.22to0.84, P = 0.01),while combination therapy had a higher expulsion rate (2.49 95%CI 1.44to4.29, P = 0.001) and shorter expulsion time (− 1.98 95%CI -3.08to0.88, P = 0.0004) than tamsulosin. As for lower urinary tract symptoms, our analysis indicated adrenoceptor1 blockers was more effective than phosphodiesterase5 inhibitors on decreasing International Prostate Symptom Score (1.96 95%CI 0.03to3.89, P = 0.05) and Post-Void Residual (9.41 95%CI 1.40to14.41, P = 0.02) and phosphodiesterase5 inhibitors showed a greater effect than adrenoceptor1 blockers on improving Erectile Dysfunction (2.23 95%CI 1.24to3.22, P<0.0001).Combination therapy had a significantly better effect on International Prostate Symptom Score (1.47 95%CI 1.25to1.69, P<0.0001), Maximum flow rate (0.87 95%CI 0.71to1.04, P<0.0001), Post-Void Residual (10.74 95%CI 3.53to17.96,P = 0.004) and Quality of life (0.59 95%CI 0.22to0.97, P = 0.002) but was associated with higher incidences of adverse events (3.40 95%CI 1.82to6.36, P = 0.0001) than adrenoceptor1 blockers. Combination therapy had a significantly better effect on International Prostate Symptom Score (4.19 95%CI 3.34to5.04, P<0.0001), Maximum flow rate (1.86 95%CI 1.32to2.39, P<0.0001), Post-Void Residual (22.58 95%CI 9.13to36.04, P = 0.001) and Quality of life (0.68 95%CI 0.37to1.00, P<0.0001) without higher incidences of adverse events than PDE5-Is.ConclusionsIn conclusion, this meta-analysis suggested combination therapy had a best efficacy of therapy for lower ureteric stones or lower urinary tract symptoms correlated with benign prostatic hyperplasia than monotherapy. Adrenoceptor1 blockers was more effective than phosphodiesterase5 inhibitors on International Prostate Symptom Score and Post-Void Residual. Both monotherapy and combination therapy were safe.
Highlights
Lower ureteric stones and lower urinary tract symptoms are common in urology.Drug treatment is one of standard therapy,but the efficacy was controversial. we aimed to investigate the efficacy and safety of monotherapy or combination therapy of adrenoceptor1 blockers and phosphodiesterase5 inhibitors for treatment
Benign prostatic hyperplasia (BPH) is characterized by nonmalignant hyperplasia of prostatic tissue and is caused by proliferation of smooth muscle (SM) and epithelial cell in the transition zone of prostate.BPH is common in aging men and could result in bothersome lower urinary tract symptoms correlated with BPH (LUTS/BPH) which decrease Quality of life (QoL) by interrupting sleep and daily activities [1, 2]
As for Lower urinary tract symptoms (LUTS)/BPH, our pooled results suggested that Adrenoceptor1 blockers (ABs) had a significantly better effect than phosphodiesterase5 inhibitors (PDE5-Is) on the reduction of International prostate symptom score (IPSS) and Post-Void Residual (PVR) without significant difference of Maximum flow rate (Qmax) and QoL
Summary
Lower ureteric stones and lower urinary tract symptoms are common in urology.Drug treatment is one of standard therapy,but the efficacy was controversial. we aimed to investigate the efficacy and safety of monotherapy or combination therapy of adrenoceptor blockers and phosphodiesterase inhibitors for treatment. Benign prostatic hyperplasia (BPH) is characterized by nonmalignant hyperplasia of prostatic tissue and is caused by proliferation of smooth muscle (SM) and epithelial cell in the transition zone of prostate.BPH is common in aging men and could result in bothersome lower urinary tract symptoms correlated with BPH (LUTS/BPH) which decrease Quality of life (QoL) by interrupting sleep and daily activities [1, 2]. In the US, approximately 75% of males from 60 to years old and 83% of men aged years or older are estimated to have got LUTS/BPH, and the annual direct medical cost due to management is more than $1.1 billion [3]. About 0.1% of the adult population of the US are admitted to hospital for treating urinary stones, leading to direct medical costs of more than $2 billion per year [4]. About 22% of all urinary calculus locate in the ureter, of which about 68% are found in the distal ureter [6]
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