Abstract
Alpha-adrenergic receptor blockers can be effectively used in the context of medical expulsion therapy (MET) to treat ureteric stones. This study was designed to evaluate the safety and efficacy of doxazosin in MET relative to placebo or tamsulosin. We systematically searched the PubMed, the Cochrane Library, EMBASE, Chinese Academic Database, and Web of Science databases to select randomized controlled trials (RCT) that compared the use of doxazosin with placebo or tamsulosin to treat ureteric stones. All patients we included were limited to those diagnosed with visible stones in the distal ureter. The diameter of ureteric stones does not exceed 10 mm. Eight trials comparing doxazosin with placebo or tamsulosin containing 667 patients were assessed in the final analysis. The meta-analysis showed that doxazosin effectively treated ureteric stones and was better than placebo in terms of efficacy. Relative to the placebo group, the expulsion rate of stones from the distal ureter (OR = 3.00, 95% CI [2.15, 4.19], I2 = 0%, P < 0.00001) was significantly increased, and the expulsion time (days) was shortened (mean difference) (MD) = -4.03, 95% CI [-4.53, -3.53], P < 0.00001). The doxazosin group experienced fewer pain episodes (MD = -0.78, CI = [-0.94, -0.23], I2 = 0%, P < 0.00001) than the placebo group. A subgroup analysis showed that the doxazosin group had a higher expulsion rate (of 5-10 mm stones) compared with the placebo group. Although doxazosin resulted in significantly more adverse effects compared with the placebo, the patient's symptoms were mild and no further medical interventions were required. Moreover, the expulsion time (days) was shorter for patients receiving doxazosin (MD = -0.61, 95% CI [-0.97, -0.24], I2 = 39%, P = 0.001) than those receiving tamsulosin. Compared with the placebo group, patients receiving doxazosin had a greater expulsion rate, a reduced expulsion time, and fewer pain episodes. The expulsion time of doxazosin was shorter than that of tamsulosin.
Highlights
Urinary calculi are frequent in urology and one of the most common causes of severe abdominal pain in the emergency department [1]
The meta-analysis showed that doxazosin effectively treated ureteric stones and was better than placebo in terms of efficacy
Ureteric calculi make up about 20% of cases of urolithiasis, and about 70% of the stones are “distal ureteric calculi (DUC)” or “lower ureteric stones (LUS)” found within the lower third of the ureter [2]
Summary
Treatment options for ureteric stones include spontaneous discharge, medical expulsion therapy (MET) [3], shock wave lithotripsy (SWL), ureteroscopic lithotripsy. The drugs used for MET include alpha-blockers, calcium channel antagonists, phosphodiesterase inhibitors, and corticosteroids, which have all been shown to promote the discharge of ureteric stones. The ureter has α1-adrenergic receptors, especially of subtype α1D, which are more numerous in the distal third of the ureter. They are important in lower ureteric physiology and affect the contraction of the detrusor and ureteric smooth muscle [5]. An increasing number of studies support the idea that α-adrenergic receptor blockers are effective treatments for ureteric stones [4, 6, 7]
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