Tamsulosin as medical expulsive therapy for lower ureterolithiasis:A meta-analysis

Objective: To review the evidence for tamsulosin as medical expulsive therapy in enhancing the effectiveness of distal ureteral stone clearance rate. Methods: We searched Pubmed/Medline, Embase, CBM and the Cochrane Library up to October 2011. All randomized controlled trials in which tamsulosin was evaluated with distal ureterolithiasis were eligible for the analysis. Outcome measure assessed was stone clearance rate. Two authors independently assessed study quality and extracted data. All data were analyzed using RevMan 5.1. Results: Thirteen studies involving 1067 participants met the inclusion criteria. Study duration ranged from 7 to 42 d. The pooled analysis showed an improvement of 41% in stone clearance rate of tamsulosin as medical expulsive therapy for distal ureteral calculi (RR=1.41, 95% CI=1.18 to 1.70). According to stone size (6 mm<size<10 mm, 5 mm<size<6 mm, size <5 mm), the pooling effects of tamsulosin were analyzed, with a higher stone expulsion rate obtained than control (RR=1.52, 1.75, 1.05, 95% CI=1.30 to 1.77, 1.25 to 2.45, 0.95 to 1.16, respectively). Adverse effects of tamsulosin, mainly retrograde ejaculation, dizziness and hypotension, were reported in 7 included trials. Conclusion: Treatment with tamsulosin appears to be a safe and effective medical expulsion therapy for distal ureterolithiasis. To make a definite clinical recommendation to use tamsulosin as medical expulsive treatment for distal ureteral calculi, high quality multicentric, randomized, double blinded, controlled trials are necessary to prove its efficacy.

Medical expulsion therapy for urinary calculi

C urrently, the predominant therapy for urinary calculi is minimally invasive treatment, which could reduce injury to patients while enhancing the success rate, compared to traditional open surgery. Minimally invasive treatments in urinary system include extracorporeal shock wave lithotripsy （ESWL）, percutaneous nephro- stolithotomy （PCNL）, ureteroscopic lithotripsy （URSL）, laparoscopy, and so on. Despite the relative small injury,

Comparison of tamsulosin with extracorporeal shock wave lithotripsy in treating distal ureteral stones

Background Tamsulosin, an alpha-1 receptor antagonist, has been demonstrated effective in promoting distal ureteral stone passage and in reducing pain associated with stone expulsion. This study aimed to evaluate the effect of tamsulosin in comparison with nifedipine and extracorporeal shock wave lithotripsy （ESWL） on the expulsion rate of distal ureteral stones at different sizes. Methods We assigned 314 patients to three categories： Ⅰ, the stone with maximal diameter of 4.0-5.9 mm; Ⅱ, 6.0-7.9 mm, and Ⅲ, 8.0-9.9 mm. Patients in each category were randomly subdivided into three treatment subgroups： group A （nifedipine group）, group B （tamsulosin group）, and group C （ESWL group）. Stone-free rate and the dose of analgesics were recorded weekly during the 4-week follow-up period. Results Three hundred and three patients completed the study. The results showed that nifedipine and tamsulosin treatments promoted a small （4-8 mm, categories Ⅰ and Ⅱ） stone expulsive rate that was comparable with ESWL treatment. Nonetheless, when the stone diameter was 8.0-9.9 mm, ESWL showed a greater stone free rate than nifedipine and tamsulosin treatments; no significant difference existed between the latter two therapies. Although the ESWL treatment group required the least analgesics, tamsulosin treatments required less pain medication than nifedipine （P 〈0.05）. Conclusions Tamsulosin treatment is recommended for patients with the stone diameter smaller than 8 mm because of its feasibility, effectiveness and safety. ESWL is more appropriate than tamsulosin therapy for the patients whose stones are larger than 8 mm.