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Tamsulosin for treatment of unilateral distal ureterolithiasis: a systematic review and metaanalysis

Published online by Cambridge University Press:  04 March 2015

Christian Malo ,
Jean-Sébastien Audette-Côté ,
Marcel Émond  and
Alexis F. Turgeon
Christian Malo*
Affiliation:
Department of Family and Emergency Medicine, Université Laval, Québec City, QC
Jean-Sébastien Audette-Côté
Affiliation:
Department of Family and Emergency Medicine, Université Laval, Québec City, QC
Marcel Émond
Affiliation:
Department of Family and Emergency Medicine, Université Laval, Québec City, QC Axe de recherche en Traumatologie - Urgence - Soins intensifs, School of Public Health, Centre de recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Québec City, QC
Alexis F. Turgeon
Affiliation:
Axe de recherche en Traumatologie - Urgence - Soins intensifs, School of Public Health, Centre de recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Québec City, QC Division of Critical Care Medicine, Department of Anesthesiology, Université LavalQuébec City, QC
*
Axe de recherche en Traumatologie-Urgence-Soins intensifs, Centre de recherche du CHU de Québec, Hôpital Enfant-Jésus, 1401, 18iéme rue, Québec, QC G1J 1Z4; [email protected]

Abstract

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Objectives:

The lifetime prevalence of ureterolithiasis is approximately 13% for men and 7% for women in the United States. Tamsulosin, an α-antagonist, has been used as therapy to facilitate the expulsion of lithiasis. Whether it is a good treatment for distal lithiasis remains controversial. We conducted a systematic review and meta-analysis to evaluate the effect of tamsulosin on the passage of distal ureterolithiasis.

Methods:

A systematic search was conducted using MEDLINE, EMBASE, and Cochrane Central. Trial eligibility was evaluated by two investigators. All randomized controlled trials (RCTs) comparing tamsulosin to standard therapy or placebo for the treatment of a single distal ureterolithiasis ≤ 10 mm in adult patients with renal colic confirmed by radiographic imaging were included. Data extraction was conducted in duplicate. Primary outcome was the expulsion rate, and secondary outcomes were the mean time for ureterolithiasis expulsion, analgesic requirements, and side effects. Mantel-Haenszel random effect models were used, and heterogeneity was assessed using I2 statistics. Data were presented with relative risks (RRs).

Results:

The search strategy identified 685 articles, of which 22 studies were included. Combined results suggested a benefit for the expulsion of ureterolithiasis (≥ 10 mm) when tamsulosin was used compared to a standard treatment (RR 1.50 [95% CI 1.31–1.71], I2 = 70%). A decrease in the average time of expulsion of the ureterolithiasis of 3.33 days in favour of tamsulosin was observed (95% CI −4.23, −2.44], I2 = 67%).

Conclusion:

Tamsulosin increases the rate of spontaneous passage of distal ureterolithiasis (≤ 10 mm).

Keywords

αantagonistα-blockernephrolithiasisrenal colictamsulosinureterolithiasis
Type
State of the Art • À la fine pointe
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 3 , May 2014 , pp. 229 - 242
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

References

REFERENCES

1. Stamatelou, KK, Franci, ME, Jones, CA, et al. Time trends in reported prevalence of kidney stones in the United States: 1976–1994. Kidney Int 2003;63:1817, doi:10.1046/j.1523-1755.2003.00917.x.Google Scholar
2. Marx, J. Rosen’s emergency medicine. Vol 1. 7th ed. Philadelphia: Elsevier; 2010.Google Scholar
3. Pearle, MS, Calhoun, EA, Curhan, GC. Urologic Diseases in America Project: urolithiasis. J Urol 2005;173:848–57, doi:10.1097/01.ju.0000152082.14384.d7.Google Scholar
4. Coll, DM, Varanelli, MJ, Smith, RC. Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. AJR Am J Roentgenol 2002;178:101–3, doi:10.2214/ajr.178.1.1780101.CrossRefGoogle ScholarPubMed
5. Türk, C, Knoll, T, Petrik, A, et al. Guidelines on urolithiasis European Association of Urology 2010. Available at: (accessed November 10, 2011).Google Scholar
6. Chandhoke, PS. When is medical prophylaxis cost-effective for recurrent calcium stones? J Urol 2002;168:937–40, doi:10.1016/S0022-5347(05)64546-6.Google Scholar
7. Daniels, GJ. Ureteroscopic results and complications: experience with 130 cases. J Urol 1988;139:710–3.Google Scholar
8. Seitz, C, Liatsikos, E, Porpiglia, F, et al. Medical therapy to facilitate the passage of stones: what is the evidence? Eur Urol 2009;56:455–71, doi:10.1016/j.eururo.2009.06.012.CrossRefGoogle ScholarPubMed
9. Hollingsworth, JM, Rogers, MA, Kaufman, SR, et al. Medical therapy to facilitate urinary stone passage: a metaanalysis. Lancet 2006;368:1171–9, doi:10.1016/S0140-6736(06)69474-9.Google Scholar
10. Singh, A, Alter, HJ, Littlepage, A. A systematic review ofmedical therapy to facilitate passage of ureteral calculi. Ann Emerg Med 2007;50:552–63, doi:10.1016/j.annemergmed.2007.05.015.Google Scholar
11. Parsons, JK, Hergun, LA, Sukamoto, K, et al. Efficacy of ablockers for the treatment of ureteral stones. J Urol 2007;177:983–7, doi:10.1016/j.juro.2006.10.023.Google Scholar
12. Chan, CW, Tekwani, KL, Watts, HF, et al. Emergency physicians report infrequent use of (alpha)-blockade for the treatment of ureteral stones. Am J Emerg Med 2009;27:776–8, doi:10.1016/j.ajem.2008.06.007.Google Scholar
13. Stroup, SP, Garvin, AN, Irby, J, et al. Practice patterns of primary care providers and urologists for use of medical expulsion therapy. Mil Med 2010;175:883–9.Google Scholar
14. Vincendeau, S, Bellissant, E, Houlgatte, A, et al. Lack of efficacy of tamsulosin in the treatment of distal ureteral stones. Arch Intern Med 2010;170:2021–7, doi:10.1001/archinternmed.2010.447.Google Scholar
15. 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;66:712–5, doi:10.1016/j.urology.2005.04.055.Google Scholar
16. Porpiglia, F, Vaccino, D, Billia, M, et al. Corticosteroids and tamsulosin in the medical expulsive therapy for symptomaticdistal ureter stones: single drug or association? Eur Urol 2006;50:339–44, doi:10.1016/j.eururo.2006.02.023.Google Scholar
17. Porpiglia, F, Ghignone, G, Fiori, C, et al. Nifedipine versus tamsulosin for themanagement of lower ureteral stones. J Urol 2004;172:568–71, doi:10.1097/01.ju.0000132390.61756.ff.Google Scholar
18. Dellabella, M, Milanese, G, Muzzonigro, G. Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J Urol 2003;170:2202–5, doi:10.1097/01.ju.0000096050.22281.a7.Google Scholar
19. 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;174:167–72, doi:10.1097/01.ju.0000161600.54732.86.Google Scholar
20. Erkan, E, Toktas, GM, Kocaaslan, R, et al. Efficacy of tamsulosin and deflazacort in management of distal ureteral stones: a prospective randomized trial. Eur Urol Suppl 2010;9:581, doi:10.1016/S1569-9056(10)61380-2.Google Scholar
21. Higgins, JPT, Green, S, editors. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. 2011. Available at: (accessed June 30, 2013).Google Scholar
22. Porpiglia, F, Fiori, C, Ghignone, G, et al. A second cycle of tamsulosin in patients with distal ureteric stones: a prospective randomized trial. BJU Int 2009;103:1700–3,doi:10.1111/j.1464-410X.2008.08295.x.Google Scholar
23. Ochoa-Gomez, R, Prieto-Diaz-Chavez, E, Trujillo-Hernandez, B, et al. Tamsulosin does not have greater efficacy than conventional treatment for distal ureteral stone expulsion in Mexican patients. Urol Res 2011;39:491–5, doi:10.1007/s00240-011-0380-z.Google Scholar
24. Abdel-Meguid, TA, Tayib, A, Al-Sayyad, A. Tamsulosin to treat uncomplicated distal urerteral calculi: a double blind randomized placebo-controlled trial. Can J Urol 2010;17:5178–83.Google Scholar
25. Ahmed, AF, Al-Sayed, AY. Tamsulosin versus alfuzosin in the treatment of patients with distal ureteral stones: prospective, randomized, comparative study. Korean J Urol 2010;51:193–7, doi:10.4111/kju.2010.51.3.193.Google Scholar
26. Agrawal, M, Gupta, M, Gupta, A, et al. Prospective randomized trial comparing efficacy of alfuzosin and tamsulosin in management of lower ureteral stones. Urology 2009;73:706–9, doi:10.1016/j.urology.2008.11.013.CrossRefGoogle ScholarPubMed
27. Al-Ansari, A, Al-Naimi, A, Alobaidy, A, et al. Efficacy of tamsulosin in the management of lower ureteral stones: a randomized double-blind placebo-controlled study of 100 patients. Urology 2010;75:4–7, doi:10.1016/j.urology.2009.09.073.Google Scholar
28. Aldemir, M, Ucgul, YE, Kayigil, O. Evaluation of the efficiency of tamsulosin and Rowatinex in patients with distal ureteral stones: a prospective, randomized, controlled study. Int Urol Nephrol 2010;43:79–83.CrossRefGoogle Scholar
29. Arrabal-Martin, M, Valle-Diaz De La Guardia, F, Arrabal-Polo, MA, et al. Treatment of ureteral lithiasis with tamsulosin: literature review and meta-analysis. Urol Int 2010;84:254–9, doi:10.1159/000288224.Google Scholar
30. 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;33:460–4, doi:10.1007/s00240-005-0508-0.Google Scholar
31. Avdoshin, VP, Andriukhin, MI, Barabash, MI, et al. Tamsulosin in the treatment of patients with ureteroliths of the lower third of the ureter clinical and pharmacoeconomic grounds. Urologiia 2005;(4):36–9.Google Scholar
32. 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;34:25–9, doi:10.1023/A:1021368325512.Google Scholar
33. 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;20:12, doi:10.1089/end.2006.20.12.Google Scholar
34. Erturhan, S, Erbagci, A, Yagci, F, et al. Comparative evaluation of efficacy of use of tamsulosin and/or tolterodine for medical treatment of distal ureteral stones. Urology 2007;69:633–6, doi:10.1016/j.urology.2007.01.009.Google Scholar
35. Ferre, RM, Wasielewski, JN, Strout, TD, et al. Tamsulosin for ureteral stones in the emergency department: a randomized, controlled trial. Ann Emerg Med 2009;54:432–9, doi:10.1016/j.annemergmed.2008.12.026.Google Scholar
36. Hermanns, T, Sauermann, P, Rufibach, K, et al. Is there a role for tamsulosin in the treatment of distal ureteral stones of 7 mm or less? Results of a randomised, double-blind, placebo-controlled trial. Eur Urol 2009;56:407–12, doi:10.1016/j.eururo.2009.03.076.Google Scholar
37. Kupeli, B, Irkilata, L, Gurocak, S, et al. Does tamsulosin enhance lower ureteral stone clearance with or without shock wave lithotripsy? Urology 2004;64:1111–5, doi:10.1016/j.urology.2004.07.020.Google Scholar
38. Lojanapiwat, B, Kochakarn, W, Suparatchatpan, N, et al. Effectiveness of low-dose and standard-dose tamsulosin in the treatment of distal ureteric stones: a randomized controlled study. J Int Med Res 2008;36:529–36, doi:10.1177/147323000803600318.Google Scholar
39. Sayed, MAB, Aboul-Yosr, AM, Abdalla, MA, et al. Efficacy of tamsulosin in medical expulsive therapy for distal ureteral calculi. Scand J Urol Nephrol 2008;42:59–62, doi:10.1080/00365590701571076.Google Scholar
40. Wang, CJ, Huang, SW, Chang, CH. Efficacy of an alpha1 blocker in expulsive therapy of lower ureteral stones. J Endourol 2008;22:41–6, doi:10.1089/end.2007.0133.Google Scholar
41. Yilmaz, E, Batislam, E, Basar, MM, et al. The comparison and efficacy of 3 different (alpha)1-adrenergic blockers for distal ureteral stones. J Urol 2005;173:2010–2, doi:10.1097/01.ju.0000158453.60029.0a.Google Scholar
42. Han, MC, Park, YY, Shim, BS. Effect of tamsulosin on the expectant treatment of additive expulsion effect of lower ureteral stones. Korean J Urol 2006;47:708–11, doi:10.4111/kju.2006.47.7.708.Google Scholar
43. Kim, JW, Cho, DY, Lee, JG. Effect of tamsulosin on the expected treatment of upper and lower ureteral stones. Korean J Urol 2007;48:724–30, doi:10.4111/kju.2007.48.7.724.Google Scholar
44. European Association of Urology. Online guidelines. Available at: (accessed November 10, 2010).Google Scholar
45. Tintinalli, JE, Kellen, GD, Stapcsynski, JS. Emergency medicine: a comprehensive guide. 6th ed. McGraw-Hill; 2004.Google Scholar