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Chen K et al, 2015: The Efficacy and Safety of Tamsulosin Combined with Extracorporeal Shockwave Lithotripsy for Urolithiasis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Chen K, Mi H, Xu G, Liu L, Sun X, Wang S, Meng Q, Lv T.
Department of Urology, The People's Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College , Shandong Province, China.
Institute of Urology and Nephrology, First Affiliated Hospital of Guangxi Medical University , Nanning, Guangxi Zhuang Autonomous Region, China.
Department of Oncology, The People's Hospital of AnQiu City , Shandong Province, China.

Abstract

BACKGROUND AND PURPOSE: Many studies have been conducted to investigate adjunctive tamsulosin therapy after extracorporeal shockwave lithotripsy (SWL) for urolithiasis. The results from those studies, however, are still inconsistent. Therefore, we performed a meta-analysis to provide an update on the clinical efficacy and safety of tamsulosin combined with SWL for urolithiasis.
METHODS: A systematic search was performed in PubMed, Cochrane Library, and Embase to identify all relevant randomized controlled trials until January 2015. Two reviewers independently assessed trial quality and extracted data. Meta-analysis was conducted with Review Manager (RevMan), version 5.1.
RESULTS: Twenty-one studies (2093 subjects in total) were identified in the current meta-analysis. Compared with a control group, the experimental group (tamsulosin combined with SWL) showed an increased overall benefit for stone expulsion, with pooled risk ratio (RR) of 1.20 (95% confidence interval [CI], 1.15-1.26). With respect to the different geographic regions, European and American had a high possibility of improvement in stone expulsion (RR: 1.33, 95% CI, 1.19-1.49). According to the stone locations (renal, upper and lower ureteral) and sizes (4-10 mm and 11-24 mm), tamsulosin is more useful for lower ureteral stone (RR: 1.28; 95% CI, 1.14-1.43) and larger sized stones (RR: 1.49; 95% CI, 1.28-1.75). The effect estimates did not vary markedly when stratified by follow-up durations but varied by dose of tamsulosin. Furthermore, a shorter expulsion time, reduced occurrence of steinstrasse, fewer incidences of colic, and lower analgesic requirements were observed within the experimental group. In addition, tamsulosin is well tolerated, and its adverse events rarely led to dropouts of patients.
CONCLUSIONS: Overall, evidence suggests that tamsulosin combined with SWL is safe and effective in enhancing stone expulsion for patients with urolithiasis. Furthermore, high-quality, randomized and placebo-controlled trials evaluating the efficacy and safety of tamsulosin should be performed. 

J Endourol. 2015 Jun 17. [Epub ahead of print]

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Comments 1

Hans-Göran Tiselius on Friday, 23 October 2015 09:36

This report is one of several meta-analyses carried out with the aim of getting information on the usefulness of -receptor antagonists after stone disintegration with SWL. For comparison the reader is referred to a recent meta-analysis on the same subject [1]. The conclusion was that this pharmacological adjuvant therapy enhances fragment expulsion. Not unexpectedly was the difference compared with controls most notable for patients with distal ureteral stones (RR 1.28). But also for large stones (RR 1.49) treatment with -receptor antagonists resulted in better stone clearance. In accordance with previously reported observations from individual studies were reduced pain and shorter time to fragment expulsion notable.

The authors conclude by stating that further randomized, placebo-controlled trials should be carried out. I am personally not sure that this is necessary. Most studies carried out so far have demonstrated similar results and I have the impression that the number of articles on this subject already is sufficiently large. Additional studies on -receptor antagonists are unlikely to change our present view and there are presently other urolithological problems that deserve greater attention.

Reference
1. Li M, Wang Z, Yang J, Guo X, Wang T, Wang S, Yin C, Liu J, Ye Z.Adjunctive medical therapy with α-blocker after extracorporeal shock wave lithotripsy of renal and ureteral stones: a meta-analysis. PLoS One. 2015 Apr 10;10(4):e0122497. doi: 10.1371/journal.pone.0122497. eCollection 2015

This report is one of several meta-analyses carried out with the aim of getting information on the usefulness of -receptor antagonists after stone disintegration with SWL. For comparison the reader is referred to a recent meta-analysis on the same subject [1]. The conclusion was that this pharmacological adjuvant therapy enhances fragment expulsion. Not unexpectedly was the difference compared with controls most notable for patients with distal ureteral stones (RR 1.28). But also for large stones (RR 1.49) treatment with -receptor antagonists resulted in better stone clearance. In accordance with previously reported observations from individual studies were reduced pain and shorter time to fragment expulsion notable. The authors conclude by stating that further randomized, placebo-controlled trials should be carried out. I am personally not sure that this is necessary. Most studies carried out so far have demonstrated similar results and I have the impression that the number of articles on this subject already is sufficiently large. Additional studies on -receptor antagonists are unlikely to change our present view and there are presently other urolithological problems that deserve greater attention. Reference 1. Li M, Wang Z, Yang J, Guo X, Wang T, Wang S, Yin C, Liu J, Ye Z.Adjunctive medical therapy with α-blocker after extracorporeal shock wave lithotripsy of renal and ureteral stones: a meta-analysis. PLoS One. 2015 Apr 10;10(4):e0122497. doi: 10.1371/journal.pone.0122497. eCollection 2015
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