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Brain E. et al., 2022: Outcomes of Alpha blockers as MET Following SWL: A Systematic Review and Meta-Analysis.

Brain E, Geraghty RM, Tzelves L, Mourmouris P, Chatzikrachtis N, Karavitakis M, Skolarikos A, Somani BK.
Newcastle Medical School, Newcastle University, Newcastle-upon-Tyne, UK.
Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK.
Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK.
Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece.
Department of Urology, University Hospital Southampton, Southampton, UK.

Abstract

Objectives: To determine stone-free rate following shockwave lithotripsy (SWL) with/without alpha-blockers as well as complication rates (individual and classified using the Clavien-Dindo system).

Materials and methods: We performed a systematic review of all randomized controlled trials that included more than 20 patients (age > 18 years) and examined the use of alpha-blockers after SWL. Meta-analysis was performed using 'metafor' in R. We report risk ratios (RRs) with 95% confidence intervals (95% CIs). The PROSPERO ID for the trial was: CRD42021248108.

Results: We assessed 158 full-text articles and included a total of 21 studies in our review. There were 1445 patients receiving alpha-blockers and 1478 control patients. Those receiving alpha-blockers were significantly more likely to be stone-free (RR 1.12, 95% CI 1.07-1.16; P < 0.001). This effect was robust to 'trim-and-fill' adjustment. In those taking alpha-blockers there was a significant reduction in Clavien III-V complications and, on trim-and-fill adjustment, a significant reduction in Clavien I-II complications. There were also significant reduction in rates of steinstrasse, pain and requirement for auxiliary procedures. There was no significant difference in retreatment rates. These effects were robust to trim-and-fill adjustment.

Conclusions: There is a modest increase in stone-free rates in those receiving alpha-blockers following SWL, with a reciprocal modest risk reduction for steinstrasse, pain and auxiliary procedures. However, alpha-blockers do not reduce the risk of requiring retreatment.
BJU Int. 2022 Sep 26. doi: 10.1111/bju.15901. Online ahead of print. PMID: 36156845 Review.

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Comments 1

Hans-Göran Tiselius on Monday, 26 December 2022 09:30

The authors compared the effect of tamsulosin and no other treatment than diclofenac on results of SWL. The conclusion was that that tamsulosin did not significantly increase the stone-free rate. The problem is that they also included stones as small as 5 mm for which the effect is less likely to show up in a comparative study. Interestingly, they found a more marked difference for stones 11-20 mm!

The advantage of this report is that the authors added their own randomized data instead of only referring to previously published data in the literature.

Looking at the literature it is evident that tamsulosin only results in marginally better stone clearance and from Table 3 in the article, it is evident that only three out of eleven studies presented significant differences between tamsulosin and placebo/controls.

In summary, the overall stone-free rate in tamsulosin treated patients was 80 % compared with 66 % in placebo/control patients. In patients treated with doxazosin the stone-free rate was 78 %.

The conclusion is that for stone > 5 mm, given the safety of the treatment, tamsulosin sometimes might be beneficial.

Hans-Göran Tiselius

The authors compared the effect of tamsulosin and no other treatment than diclofenac on results of SWL. The conclusion was that that tamsulosin did not significantly increase the stone-free rate. The problem is that they also included stones as small as 5 mm for which the effect is less likely to show up in a comparative study. Interestingly, they found a more marked difference for stones 11-20 mm! The advantage of this report is that the authors added their own randomized data instead of only referring to previously published data in the literature. Looking at the literature it is evident that tamsulosin only results in marginally better stone clearance and from Table 3 in the article, it is evident that only three out of eleven studies presented significant differences between tamsulosin and placebo/controls. In summary, the overall stone-free rate in tamsulosin treated patients was 80 % compared with 66 % in placebo/control patients. In patients treated with doxazosin the stone-free rate was 78 %. The conclusion is that for stone > 5 mm, given the safety of the treatment, tamsulosin sometimes might be beneficial. Hans-Göran Tiselius
Saturday, 18 May 2024