MP40-08 MEDICAL EXPULSIVE THERAPY FOR PEDIATRIC UROLITHIASIS: SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

You have accessJournal of UrologyPediatrics: Testis & Varicoceles, Stones1 Apr 2015MP40-08 MEDICAL EXPULSIVE THERAPY FOR PEDIATRIC UROLITHIASIS: SYSTEMATIC REVIEW AND META-ANALYSIS Nermarie Velasquez, Daniel Zapata, Hsin-Hsiao Wang, John Wiener, Michael Lipkin, and Jonathan Routh Nermarie VelasquezNermarie Velasquez More articles by this author , Daniel ZapataDaniel Zapata More articles by this author , Hsin-Hsiao WangHsin-Hsiao Wang More articles by this author , John WienerJohn Wiener More articles by this author , Michael LipkinMichael Lipkin More articles by this author , and Jonathan RouthJonathan Routh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1190AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite its well-documented success in adults, published success rates of medical expulsive therapy (MET) for pediatric urolithiasis vary widely. Our objective was to determine whether the aggregated evidence supports the use of MET in children. METHODS We searched the Cochrane Controlled Trials Register, clinicaltrials.gov, MEDLINE, EMBASE databases and recent meeting abstracts for reports in any language. The bibliographies of included studies were then hand-searched. Manuscripts were assessed and data abstracted in duplicate with differences resolved by the senior author. Risk of bias was assessed using standardized instruments. The primary outcome was the odds ratio (OR) of spontaneous stone passage vs. placebo/NSAID. Descriptive statistical analyses were performed using OR and 95% confidence intervals (95% CI) as appropriate. For univariate pooling and meta-regression, standard Dersimonian-Laird random-effects models were used. RESULTS We identified 11,197 studies, 5 of which (3 randomized controlled trials, 2 retrospective cohorts) were included in the pooled meta-analysis of 465 patients. Mean patient ages ranged from 5.6-14.5 years. Included study populations were from Turkey, Egypt, and the United States. All studies only used alpha-adrenergic blockers (tamsulosin/doxazosin). Pooled results demonstrate that MET increased the odds of spontaneous stone passage (OR 2.21, 95% CI 1.40-3.49, p=0.0007). Between-study heterogeneity was not significant (I2=14%, p=0.36). Univariate meta-regression models revealed no significant association between the likelihood of stone passage and COI (0.9), country (p=0.7), age (p=0.4), gender (p=0.4), follow-up (p=0.3), or stone size (p=0.7). There was little evidence of publication bias via funnel plot. Selection bias could not be ruled out in any study. Adverse effects of MET were reportedly minimal (1 study withdrawal out of 465 included patients). CONCLUSIONS Consistent with the adult literature, pediatric studies demonstrate that MET results increases the odds of spontaneous stone passage with a low rate of adverse events. However, due to inconsistent reporting it is unclear whether published studies are at risk of bias. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e465-e466 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nermarie Velasquez More articles by this author Daniel Zapata More articles by this author Hsin-Hsiao Wang More articles by this author John Wiener More articles by this author Michael Lipkin More articles by this author Jonathan Routh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...