Tamsulosin versus nifedipine for the management of lower ureteral stones: a meta-analysis

Abstract

Objective To compare the efficacy and safety of tamsulosin with nifedipine for medical expulsive therapy (MET) in patients with lower ureteral stones (LUS). Methods Randomized controlled trials(RCTs)in comparison of tamsulosin and nifedipine in treatment of LUS published in Pubmed, Cochrane Library, Embase, CNKI, CBM, Wanfang and VIP from databases establishment to July 2015 were retrieved. According to Cochrane handbook, the quality of included RCTs were assessed, and the relevant data including the number of participants, stone size, stone expulsion rate, time to stone expulsion, drug-related side effect, the incidence of ESWL or ureteroscopy lithotripsy (URSL) after MET and analgesic dose were extracted by two reviewers independently. The statistical software RevMan 5.2 was used for meta-analysis with regard to the stone expulsion rate, the incidence of ESWL or URSL and adverse effects. This study lasted more than one month from June to July 2015. Results A total of 13 RCTs with 4 831 patients were eligible. The results showed that the stone expulsion rate and the incidence rate of ESWL or URSL after MET were 92%(2 221/2 423) and 8%(27/333) in the tamsulosin group, and 73%(1 748/2 408) and 20%(67/328) in the nifedipine group. There are statistically significant differences(RR=1.24, 95% CI 1.13-1.37, P<0.05; RR=0.40, 95% CI 0.27-0.60, P<0.05, respectively). The subgroup analysis indicated no statistically significant differences in drug-related adverse effects between tamsulosin and nifedipine with 5%(99/1 804)and 7% (117/1 796) minor adverse effects respectively and less than 1% severe adverse effects in both groups(RR=0.85, 95% CI 0.65-1.10, P=0.21; RR=0.49, 95% CI 0.09-2.59, P= 0.40). Conclusion Compared to nifedipine, tamsulosin has higher stone expulsion rate and lower incidence rates for ESWL or URSL. Since there was no obvious adverse effects, tamsulosin could be considered as a preferable option for patients with LUS. Key words: Tamsulosin; Nifedipine; Medical expulsive therapy; Ureteral stones; Meta-analysis