OBJECTIVES: Many studies have been conducted to investigate the adjunctive tamsulosin therapy after Extracorporeal shockwave lithotripsy (SWL) for urolithiasis.
However, the results from those studies 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 (RCTs) 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 control group, Experimental group (tamsulosin combined with SWL) showed an increased overall benefit for stone expulsion, with pooled RR of 1.20 [95% 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 stone locations (renal, upper and lower ureteral) and sizes (4-10 mm and 11-24 mm), tamsulosin are more useful for lower ureteral stone (RR: 1.28; 95% CI, 1.14 -1.43) and stone with a larger sizes (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 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.
Written by:
Chen K, Mi H, Xu G, Liu L, Sun X, Wang S, Meng Q, Lv T. Are you the author?
The People's Hospital of Laiwu City, Department of Urology, 1 Xuehu Street, LaiWu, Shandong, China, 271100.
Reference: J Endourol. 2015 Apr 27. Epub ahead of print.
doi: 10.1089/end.2015.0098
PubMed Abstract
PMID: 25915454