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Li M et al, 2015: Adjunctive medical therapy with α-blocker after extracorporeal shock wave lithotripsy of renal and ureteral stones: a meta-analysis.

Li M, Wang Z, Yang J, Guo X, Wang T, Wang S, Yin C, Liu J, Ye Z.
Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, P. R. China.
Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China.
Department of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Abstract

BACKGROUND: Although some trials assessed the efficacy and safety of the α-blocker in facilitating renal and ureteral stones expulsion after extracorporeal shock wave lithotripsy (ESWL), the role of the α-blocker in facilitating upper urinary calculi expulsion after ESWL remain controversial.
AIMS: To determine the efficacy and safety of the α-blocker in facilitating renal and ureteral stones expulsion after ESWL.
METHODS: A literature search was carried out using the PubMed database, EMBASE and the Cochrane Library database to identify relevant studies. Two reviewers independently extracted data and assessed methodological quality. Pooled effect estimates were obtained using a fixed- and random-effects meta-analysis.
RESULTS: The meta-analysis included 23 RCTs, α-blocker significantly enhanced expulsion rate of upper urinary tract calculi after ESWL (P<0.00001; RR 1.21; 95% CI 1.12-1.31), significantly promoted steinstrasse expulsion (P=0.03; RR 1.25; 95% CI 1.03-1.53), significantly shortened the discharge time of upper urinary tract calculi (P=0.0001; MD -2.12; 95% CI -3.20--1.04), significantly reduced the patient's pain VAS score (P=0.001; RR -1.0; 95% CI -1.61--0.39). Compared with the control group, dizziness (P=0.002; RR 5.48; 95% CI 1.91- 5.77),
anejaculation (P=0.02; RR 12.17; 95% CI 1.61-91.99) and headache (P=0.04; RR 4.03; 95% CI 1.04-15.72) in the α-blocker group was associated with a higher incidence.
CONCLUSIONS: Treatment with α-blocker after ESWL appears to be effective in enhancing expulsion rate of upper urinary tract calculi, shortening the discharge time of upper urinary tract calculi, reducing the patient's pain. The side effects of α-blocker were light and few.

PLoS One. 2015 Apr 10;10(4):e0122497. doi: 10.1371/journal.pone.0122497. eCollection 2015

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Hans-Göran Tiselius on Friday, 06 November 2015 09:53

Several meta-analyses have been published on the efficacy of -receptor antagonists in terms of fragment elimination after SWL. For further information and comparison the reader is referred to a recent article on the same subject [1]. Most reports have had the focus on results following treatment of ureteral stones. The advantage of this study, and in that referred to above,is that in addition to patients with ureteral stones, also those with renal stones [1] and steinstrasse were included in the evaluation. Altogether the authors succeeded to get almost 1000 patients in the treated as well as in the control groups.

Improved fragment elimination was recorded and there was also a shorter time to fragment/stone expulsion. It is of interest to note that expulsion rate expressed as risk ratio was higher for large than small stones. The recorded increased expulsion rate for renal stones is particularly interesting and valuable information. The analysis of reported data confirmed previously reported observations on reduced pain experience and also that the side effects of this pharmacological treatment usually were mild. Most studies were carried out with daily doses of 0.4 mg of tamsulosin, but if this dose is superior to 0.2 mg is only vaguely suggested in this report.

Reference
1. Chen K, Mi H, Xu G, Liu L, Sun X, Wang S, Meng Q, Lv T.The Efficacy and Safety of Tamsulosin Combined with Extracorporeal Shockwave Lithotripsy for Urolithiasis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.J Endourol. 2015 Jun 17. [Epub ahead of print]

Several meta-analyses have been published on the efficacy of -receptor antagonists in terms of fragment elimination after SWL. For further information and comparison the reader is referred to a recent article on the same subject [1]. Most reports have had the focus on results following treatment of ureteral stones. The advantage of this study, and in that referred to above,is that in addition to patients with ureteral stones, also those with renal stones [1] and steinstrasse were included in the evaluation. Altogether the authors succeeded to get almost 1000 patients in the treated as well as in the control groups. Improved fragment elimination was recorded and there was also a shorter time to fragment/stone expulsion. It is of interest to note that expulsion rate expressed as risk ratio was higher for large than small stones. The recorded increased expulsion rate for renal stones is particularly interesting and valuable information. The analysis of reported data confirmed previously reported observations on reduced pain experience and also that the side effects of this pharmacological treatment usually were mild. Most studies were carried out with daily doses of 0.4 mg of tamsulosin, but if this dose is superior to 0.2 mg is only vaguely suggested in this report. Reference 1. Chen K, Mi H, Xu G, Liu L, Sun X, Wang S, Meng Q, Lv T.The Efficacy and Safety of Tamsulosin Combined with Extracorporeal Shockwave Lithotripsy for Urolithiasis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.J Endourol. 2015 Jun 17. [Epub ahead of print]
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