Medical Expulsive Therapy for Ureteral Calculi with Tamsulosin: Evidence from A Meta-analysis of Randomized Controlled Trials_Chinese Journal of Evidence-Based Medicine

Authors：

XIONG Wei ¹² , WANG Kunjie ¹ , WANG Li ³ , WANG Jia ¹ , WEI Qiang ¹ ,  LI Hong ¹

1. Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, China2. Multi-Organ Transplant Unit, Department of Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu 6100723. Chinese Cochrane Center, West China Hospital, West China Medical School, Sichuan University;

Corresponding author：

LI Hong, Email: LiHong_19560707@163.com

Keywords：

Tamsulosin; 1-adrenoreceptor antagonist; Ureteral calculi; Medical expulsive therapy; Meta-analysis; Randomized controlled trials

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Objective 　To assess the efficacy of medical expulsive therapy for ureteral calculi with tamsulosin.
Methods 　We searched PubMed, MEDLINE, EMBASE, BIOSIS, International Pharmaceutical Abstracts (IPA) Database, The Cochrane Library and Chinese Journal Full-text Database from 1995 to September 2006, as well as the proceedings of urological scientific conferences from 2000 to 2006. Randomized controlled trials(RCTs) comparing tamsulosin and other therapies for ureteral calculi among adults were included. Data were extracted by two reviewers independently and synthesized by STATA 9.0 software.
Results 　A total of 16 studies involving 1521 patients with distal or juxtavesical ureteral calculi were included. Compared with conservative therapy, tamsulosin showed higher expulsion rate [RR 1.50, 95%CI (1.20 to 1.87), P lt;0.0001], shorter expulsion time [SMD –1.29, 95%CI (–2.27, –0.31)] and fewer patients requiring ESWL or ureteroscopy [RR 0.40, 95%CI (0.27, 0.59), P lt;0.05]. Compared with conservative therapy, the combination of tamsulosin plus deflazacort also showed higher expulsion rate [RR 1.59, 95%CI (1.31, 1.93)], shorter expulsion time [SMD –0.8, 95%CI (–1.18, –0.42)] and fewer patients requiring ESWL or ureteroscopy [RR 0.13, 95%CI (0.06, 0.31), P lt;0.05]. Compared with deflazacort alone, the combination of tamsulosin plus deflazacort demonstrated similar expulsion rate [RR 1.31, 95%CI (0.78, 2.23), P=0.31], but significantly reduced the dosage of analgesics [SMD 15.20, 95%CI (14.98, 15.52)] and decreased the proportion of patients requiring ESWL or ureteroscopy [RR 0.09,, 95%CI (0.02, 0.47), P lt;0.05]. Compared with deflazacort plus nifedipine, the combination of tamsulosin plus deflazacort showed higher expulsion rate [RR 1.20, 95%CI (1.07, 1.35), P=0.002], but similar expulsion time [SMD –1.34, 95%CI (–3.47, 0.79)] and proportion of patients requiring ESWL or ureteroscopy [RR 0.34, 95%CI (0.05, 2.22), P gt;0.05]. As for side effects, tamsulosin-based treatment and conservative therapy were comparable (P gt;0.05).
Conclusions 　Tamsulosin has a beneficial effect on the expulsion of ureteral calculi, especially for distal and juxtavesical ureteral calculi. Tamsulosin-based medical expulsive therapy at the dosage of 0.4mg daily is effective and safe for patients with distal ureteral calculi. More large-scale studies are required to define the efficacy of combination therapy of tamsulosin plus deflazacort.

Citation： XIONG Wei,WANG Kunjie,WANG Li,WANG Jia,WEI Qiang,LI Hong. Medical Expulsive Therapy for Ureteral Calculi with Tamsulosin: Evidence from A Meta-analysis of Randomized Controlled Trials. Chinese Journal of Evidence-Based Medicine, 2007, 07(7): 506-515. doi: Copy

1.	Zhang XZ, Zhu X. The effect of tamsulosin and doxazosin in treatment for distal ureteral calculi-a randomized controlled trial. [in Chinese], in Association CU: The 13th annual meeting of Chinese Urological Association. SHENYANG, Chinese Urological Association, 2006: 577.
2.	Lv JJ, Wei LJ, Zhang H, et al. Comparison of tamsulosin versus nifedipine for the management of lower ureteral stones. [Chinese]. Chinese J of Urol, 2006, 27(9): 612-614.
3.	Sowter SJ, Tolley DA. The management of ureteric colic. Curr Opin Urol, 2006, 16(2): 71-76.
4.	Dal Moro F, Abate A, Lanckriet GR, et al. A novel approach for accurate prediction of spontaneous passage of ureteral stones: support vector machines. Kidney Int, 2006, 69(1): 157-160.
5.	Teichman JM. Clinical practice. Acute renal colic from ureteral calculus. N Engl J Med, 2004, 350(7): 684-693.
6.	Cervenakov I, Fillo J, Mardiak J, et al. Speedy elimination of ureterolithiasis in lower part of ureters with the alpha 1-blocker--Tamsulosin. Int Urol Nephrol, 2002, 34(1): 25-29.
7.	Dellabella M, Milanese G, Muzzonigro G. Medical-expulsive therapy for distal ureterolithiasis: randomized prospective study on role of corticosteroids used in combination with tamsulosin-simplified treatment regimen and health-related quality of life. Urology, 2005, 66(4): 712-715.
8.	Resim S, Ekerbicer HC, Ciftci A. Role of tamsulosin in treatment of patients with steinstrasse developing after extracorporeal shock wave lithotripsy. Urology, 2005, 66(5): 945-948.
9.	Kupeli B, Irkilata L, Gurocak S, et al. Does tamsulosin enhance lower ureteral stone clearance with or without shock wave lithotripsy? Urology, 2004, 64(6): 1111-1115.
10.	Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. QUOROM Group. Br J Surg, 2000, 87(11): 1448-1454.
11.	Coll DM, Varanelli MJ, Smith RC. Relationship of Spontaneous Passage of Ureteral Calculi to Stone Size and Location as Revealed by Unenhanced Helical CT. Am J Roentgenol, 2002, 178(1): 101-103.
12.	Egger M, Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315: 629-634.
13.	Dellabella M, Milanese G, Muzzonigro G. Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J Urol, 2003, 170(6 Pt 1): 2202-2205.
14.	Porpiglia F, Ghignone G, Fiori C, et al. Nifedipine versus tamsulosin for the management of lower ureteral stones. J Urol, 2004, 172(2): 568-571.
15.	Autorino R, De Sio M, Damiano R, et al. The use of tamsulosin in the medical treatment of ureteral calculi: where do we stand? Urol Res, 2005, 33(6): 460-464.
16.	Dellabella M, Milanese G, Muzzonigro G. Randomized trial of the efficacy of tamsulosin, nifedipine and phloroglucinol in medical expulsive therapy for distal ureteral calculi. J Urol, 2005, 174(1): 167-172.
17.	Resim S, Ekerbicer H, Ciftci A. Effect of tamsulosin on the number and intensity of ureteral colic in patients with lower ureteral calculus. Int J Urol, 2005, 12(7): 615-620.
18.	Yilmaz E, Batislam E, Basar MM, et al. The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones. J Urol, 2005, 173(6): 2010-2012.
19.	De Sio M, Autorino R, Di Lorenzo G, et al. Medical expulsive treatment of distal-ureteral stones using tamsulosin: a single-center experience. J Endourol, 2006, 20(1): 12-16.
20.	Porpiglia F, Vaccino D, Billia M, et al. Corticosteroids and tamsulosin in the medical expulsive therapy for symptomatic distal ureter stones: single drug or association? Eur Urol, 2006, 50(2): 339-344.
21.	Taghavi R, Mahdavi R, Darabi MR, et al. The effect of tamsulosin in the passage of juxtavesical stones. Int J Urol, 2006, 13 (Suppl 1): A39.
22.	Hong Y, Lee Y, Lee J, et al. Medical Therapy for Lower Ureteral Lithiasis: Prospective Study Using Tamsulosin in Combination with Furosemide. Int J Urol, 2006, 13(Suppl 1): A6.
23.	Puthenveetil R, Deka P, Barua S, et al. Role of tamsulosin in the management of patients with pre-vesical ureteral calculi. Urology, 2006, 68(Suppl 1): 81-81.
24.	张选志, 朱煊. 两种不同α1受体阻滞剂——坦索罗辛和多沙唑嗪在治疗输尿管下段结石上的应用. 见: 第十三届全国泌尿外科学术会议暨第八届全球华人泌尿外科学术会议. 沈阳: 中华医学会泌尿外科学分会; 2006: 577.
25.	吕家驹, 尉立京, 张辉, 等. 坦索罗辛和硝苯地平在输尿管下段结石辅助排石中作用的比较. 中华泌尿外科杂志, 2006, 27(9): 612-614.
26.	Sigala S, Dellabella M, Milanese G, et al. Evidence for the presence of alpha1 adrenoceptor subtypes in the human ureter. Neurourol Urodyn, 2005, 24(2): 142-148.
27.	Tiselius HG, Ackermann D, Alken P, et al. Guidelines on urolithiasis. Eur Urol, 2001, 40(4): 362-371.
28.	Yucel S, Baskin LS. Neuroanatomy of the ureterovesical junction: clinical implications. J Urol, 2003, 170(3): 945-948.
29.	Hollingsworth JM, Rogers MAM, Kaufman SR, et al. Medical therapy to facilitate urinary stone passage: a meta-analysis. Lancet, 2006, 368(9542): 1171-1179.
30.	Tekin A, Alkan E, Beysel M, et al. Alpha-1 receptor blocking therapy for lower ureteral stones: a randomized prospective trial (abstract). J Urol, 2004, 171(suppl): 304.
31.	Porpiglia F, Destefanis P, Fiori C, et al. Effectiveness of nifedipine and deflazacort in the management of distal ureter stones. Urology, 2000, 56(4): 579-582.
32.	Porpiglia F, Destefanis P, Fiori C, et al. Role of adjunctive medical therapy with nifedipine and deflazacort after extracorporeal shock wave lithotripsy of ureteral stones. Urology, 2002, 59(6): 835-838.
33.	Roehrborn CG. Are all alpha-blockers created equal? An update. Urology, 2002, 59(2 Suppl 1): 3-6.
34.	Roehrborn CG, Schwinn DA. Alpha1-adrenergic receptors and their inhibitors in lower urinary tract symptoms and benign prostatic hyperplasia. J Urol, 2004, 171(3): 1029-1035.

1. Zhang XZ, Zhu X. The effect of tamsulosin and doxazosin in treatment for distal ureteral calculi-a randomized controlled trial. [in Chinese], in Association CU: The 13th annual meeting of Chinese Urological Association. SHENYANG, Chinese Urological Association, 2006: 577.
2. Lv JJ, Wei LJ, Zhang H, et al. Comparison of tamsulosin versus nifedipine for the management of lower ureteral stones. [Chinese]. Chinese J of Urol, 2006, 27(9): 612-614.
3. Sowter SJ, Tolley DA. The management of ureteric colic. Curr Opin Urol, 2006, 16(2): 71-76.
4. Dal Moro F, Abate A, Lanckriet GR, et al. A novel approach for accurate prediction of spontaneous passage of ureteral stones: support vector machines. Kidney Int, 2006, 69(1): 157-160.
5. Teichman JM. Clinical practice. Acute renal colic from ureteral calculus. N Engl J Med, 2004, 350(7): 684-693.
6. Cervenakov I, Fillo J, Mardiak J, et al. Speedy elimination of ureterolithiasis in lower part of ureters with the alpha 1-blocker--Tamsulosin. Int Urol Nephrol, 2002, 34(1): 25-29.
7. Dellabella M, Milanese G, Muzzonigro G. Medical-expulsive therapy for distal ureterolithiasis: randomized prospective study on role of corticosteroids used in combination with tamsulosin-simplified treatment regimen and health-related quality of life. Urology, 2005, 66(4): 712-715.
8. Resim S, Ekerbicer HC, Ciftci A. Role of tamsulosin in treatment of patients with steinstrasse developing after extracorporeal shock wave lithotripsy. Urology, 2005, 66(5): 945-948.
9. Kupeli B, Irkilata L, Gurocak S, et al. Does tamsulosin enhance lower ureteral stone clearance with or without shock wave lithotripsy? Urology, 2004, 64(6): 1111-1115.
10. Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. QUOROM Group. Br J Surg, 2000, 87(11): 1448-1454.
11. Coll DM, Varanelli MJ, Smith RC. Relationship of Spontaneous Passage of Ureteral Calculi to Stone Size and Location as Revealed by Unenhanced Helical CT. Am J Roentgenol, 2002, 178(1): 101-103.
12. Egger M, Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315: 629-634.
13. Dellabella M, Milanese G, Muzzonigro G. Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J Urol, 2003, 170(6 Pt 1): 2202-2205.
14. Porpiglia F, Ghignone G, Fiori C, et al. Nifedipine versus tamsulosin for the management of lower ureteral stones. J Urol, 2004, 172(2): 568-571.
15. Autorino R, De Sio M, Damiano R, et al. The use of tamsulosin in the medical treatment of ureteral calculi: where do we stand? Urol Res, 2005, 33(6): 460-464.
16. Dellabella M, Milanese G, Muzzonigro G. Randomized trial of the efficacy of tamsulosin, nifedipine and phloroglucinol in medical expulsive therapy for distal ureteral calculi. J Urol, 2005, 174(1): 167-172.
17. Resim S, Ekerbicer H, Ciftci A. Effect of tamsulosin on the number and intensity of ureteral colic in patients with lower ureteral calculus. Int J Urol, 2005, 12(7): 615-620.
18. Yilmaz E, Batislam E, Basar MM, et al. The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones. J Urol, 2005, 173(6): 2010-2012.
19. De Sio M, Autorino R, Di Lorenzo G, et al. Medical expulsive treatment of distal-ureteral stones using tamsulosin: a single-center experience. J Endourol, 2006, 20(1): 12-16.
20. Porpiglia F, Vaccino D, Billia M, et al. Corticosteroids and tamsulosin in the medical expulsive therapy for symptomatic distal ureter stones: single drug or association? Eur Urol, 2006, 50(2): 339-344.
21. Taghavi R, Mahdavi R, Darabi MR, et al. The effect of tamsulosin in the passage of juxtavesical stones. Int J Urol, 2006, 13 (Suppl 1): A39.
22. Hong Y, Lee Y, Lee J, et al. Medical Therapy for Lower Ureteral Lithiasis: Prospective Study Using Tamsulosin in Combination with Furosemide. Int J Urol, 2006, 13(Suppl 1): A6.
23. Puthenveetil R, Deka P, Barua S, et al. Role of tamsulosin in the management of patients with pre-vesical ureteral calculi. Urology, 2006, 68(Suppl 1): 81-81.
24. 张选志, 朱煊. 两种不同α1受体阻滞剂——坦索罗辛和多沙唑嗪在治疗输尿管下段结石上的应用. 见: 第十三届全国泌尿外科学术会议暨第八届全球华人泌尿外科学术会议. 沈阳: 中华医学会泌尿外科学分会; 2006: 577.
25. 吕家驹, 尉立京, 张辉, 等. 坦索罗辛和硝苯地平在输尿管下段结石辅助排石中作用的比较. 中华泌尿外科杂志, 2006, 27(9): 612-614.
26. Sigala S, Dellabella M, Milanese G, et al. Evidence for the presence of alpha1 adrenoceptor subtypes in the human ureter. Neurourol Urodyn, 2005, 24(2): 142-148.
27. Tiselius HG, Ackermann D, Alken P, et al. Guidelines on urolithiasis. Eur Urol, 2001, 40(4): 362-371.
28. Yucel S, Baskin LS. Neuroanatomy of the ureterovesical junction: clinical implications. J Urol, 2003, 170(3): 945-948.
29. Hollingsworth JM, Rogers MAM, Kaufman SR, et al. Medical therapy to facilitate urinary stone passage: a meta-analysis. Lancet, 2006, 368(9542): 1171-1179.
30. Tekin A, Alkan E, Beysel M, et al. Alpha-1 receptor blocking therapy for lower ureteral stones: a randomized prospective trial (abstract). J Urol, 2004, 171(suppl): 304.
31. Porpiglia F, Destefanis P, Fiori C, et al. Effectiveness of nifedipine and deflazacort in the management of distal ureter stones. Urology, 2000, 56(4): 579-582.
32. Porpiglia F, Destefanis P, Fiori C, et al. Role of adjunctive medical therapy with nifedipine and deflazacort after extracorporeal shock wave lithotripsy of ureteral stones. Urology, 2002, 59(6): 835-838.
33. Roehrborn CG. Are all alpha-blockers created equal? An update. Urology, 2002, 59(2 Suppl 1): 3-6.
34. Roehrborn CG, Schwinn DA. Alpha1-adrenergic receptors and their inhibitors in lower urinary tract symptoms and benign prostatic hyperplasia. J Urol, 2004, 171(3): 1029-1035.

Chinese Journal of Evidence-Based Medicine

Medical Expulsive Therapy for Ureteral Calculi with Tamsulosin: Evidence from A Meta-analysis of Randomized Controlled Trials

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