Medical Expulsive Therapy for Ureteric Stones: Analysing the Evidence from Systematic Reviews and Meta-analysis of Powered Double-blinded Randomised Controlled Trials

Overview

Journal Arab J Urol

Date 2017 Oct 27

PMID 29071136

Citations 11

Authors

Tarik Amer

Banan Osman

Allan Johnstone

Martin Mariappan

Ameet Gupta

Nikolaos Brattis

Gareth Jones

Bhaskar K Somani

Francis X Keeley Jr

Omar M Aboumarzouk

Affiliations

Soon will be listed here.

Abstract

Objective: To conduct a systematic review and meta-analysis investigating the efficacy and safety of medical expulsive therapy (MET) in low risk of bias (RoB) randomised controlled trials (RCTs).

Methods: A Cochrane style systematic review was conducted on published literature from 1990 to 2016, to include low RoB and a power calculation. A pooled meta-analysis was conducted.

Results: The MET group included 1387 vs 1381 patients in the control group. The analysis reveals α-blockers increased stone expulsion rates (78% vs 74%) ( < 0.001), whilst calcium channel blockers (CCBs) had no effect compared to controls (79% vs 75%) ( = 0.38). In the subgroup analysis, α-blockers had a shorter time to stone expulsion vs the control group ( < 0.001). There were no significant differences in expulsion rates between the treatment groups and control group for stones <5 mm in size ( = 0.48), proximal or mid-ureteric stones ( = 0.63 and = 0.22, respectively). However, α-blockers increased stone expulsion in stones >5 mm ( = 0.02), as well as distal ureteric stones ( < 0.001). The α-blocker group developed more side-effects (6.6% of patients; < 0.001). The numbers needed to treat for α-blockers was one in 14, for stones >5 mm one in eight, and for distal stones one in 10.

Conclusion: The primary findings show a small overall benefit for α-blockers as MET for ureteric stones but no benefit with CCBs. α-blockers show a greater benefit for large (>5 mm) ureteric stones and those located in the distal ureter, but no benefit for smaller or more proximal stones. α-blockers are associated with a greater risk of side-effects compared to placebo or CCBs.

Citing Articles

Evaluating the safety and effectiveness of α-blockers versus mirabegron for medical expulsive therapy in ureteral calculi: A Systematic review and meta-analysis.

Yan H, Li X, Zheng X, Cui Y, Huang J, Cheng Y PLoS One. 2024; 19(12):e0315328.

PMID: 39729463 PMC: 11676830. DOI: 10.1371/journal.pone.0315328.

Comparing silodosin and mirabegron as medical expulsive therapy for distal ureteral calculus: a prospective, randomised study.

Faridi M, Deshpande S Cent European J Urol. 2024; 77(2):286-290.

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Everaert K, Holm-Larsen T, Bou Kheir G, Rottey S, Weiss J, Walle J Exp Ther Med. 2024; 28(2):303.

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Kronenberg P World J Urol. 2024; 42(1):109.

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