Ouyang W. et al., 2020: Adjunctive medical expulsive therapy with tamsulosin for repeated extracorporeal shock wave lithotripsy: a systematic review and meta-analysis
Ouyang W, Sun G, Long G, Liu M, Xu H, Chen Z, Ye Z, Li H, Zhang Y.
Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Purpose: To evaluate the efficacy of adjunctive medical expulsive therapy (MET) with tamsulosin for the promotion of stone fragments clearance for repeated extracorporeal shock wave lithotripsy (ESWL).
Materials and methods: This meta-analysis was conducted by systematic search for randomized controlled trial (RCT) studies in PubMed/Medline, Scopus, Cochrane Library, Web of Science databases in January 2020, which compared tamsulosin with either placebo or non-placebo control for repeated ESWL. The primary endpoint was stone-free rate (SFR), the second endpoints were stone clearance time and complications. The quality assessment of included studies was performed by using the Cochrane System and Jadad score.
Results: 7 RCTs were included in this meta-analysis. Tamsulosin provided higher SFR (for stones larger than 1cm, OR: 5.56, p=0.0003), except for patients with stones less than 1cm. For patients with renal stones (OR: 2.97, p=0.0005) or upper ureteral stones (OR: 3.10, p=0.004), tamsulosin can also provide a higher SFR. In addition, tamsulosin provided a shorter stone clearance time (WMD: -9.40, p=0.03) and lower pain intensity (WMD=-17.01, p< 0.0001) and incidences of steinstrasse (OR: 0.37, p=0.0002).
Conclusion: Adjunctive MET with tamsulosin is effective in patients with specific stone size or location that received repeated ESWL. However, no well-designed RCT that used computed tomography for the detection and assessment of residual stone fragments was found. More studies with high quality and the comparison between tamsulosin and secondary ESWL are needed in the future.
Int Braz J Urol. 2020 Apr 10;46. doi: 10.1590/S1677-5538.IBJU.2020.0093. PMID: 32459454. Online ahead of print.
This article is one of many in which the effect of alpha-receptor antagonists on stone clearance have been studied.
The authors of this report extracted and analysed information from 7 RCTs with the aim of establishing if Tamsulosin affected the result of SWL. Patients in focus were those treated with repeated SWL.
The most important conclusions were:
1. For patients with stones > 10 mm SFR was higher in Tamsulosin treated patients:
2. OR for renal stones was 5.56
3. OR for proximal ureteral stones was 3.10
4. Clearance time was shorter (-9.4 d)
5. Pain was reduced and so was the incidence of steinstrasse.
The bottom-line is that in patients requiring repeated SWL sessions for stones > 10 mm treatment with Tamsulosin (or other alpha receptor antagonist)