Impact of tamsulosin on ureter stone expulsion in korean patients: a meta-analysis of randomized controlled studies

Abstract

Purpose: Using meta-analysis, the study's aim was to evaluate the efficacy of tamsulosin, an alpha-blocker, in the treatment of ureteral stones with or without shockwave lithotripsy (SWL) in Korean patients.

Materials and methods: Relevant randomized controlled studies published through June 2011 were identified in a search of MEDLINE, KoreaMed, and the Korean Medical Database. No language restriction was applied. Only randomized controlled trials conducted with Korean patients were eligible for the analysis. The primary outcome assessed was the stone clearance rate. Two reviewers independently assessed the quality of the study and extracted the data. Meta-analysis was conducted by using R, version 2.13.0.

Results: A total of 6 articles were selected as being suitable for evaluation. Pooling of the trials demonstrated a 43% higher expulsion rate for tamsulosin treatment compared to a control group (risk ratio [RR], 1.43; 95% confidence interval [CI]: 1.24 to 1.65). Similar results were obtained in all subgroup analyses according to stone location (upper: RR, 1.31; 95% CI, 1.02 to 1.68, lower: RR, 1.50; 95% CI, 1.20 to 1.88) or concomitant SWL (yes: RR, 1.38; 95% CI, 1.14 to 1.68, no: RR, 1.48; 95% CI, 1.21 to 1.83).

Conclusions: This meta-analysis of randomized controlled studies provides a high level of evidence supporting the suggestion that treatment with tamsulosin augments the stone expulsion rate for ureter stones with or without SWL in a Korean population. However, a high-quality, large-scale, multicenter, randomized controlled trial is warranted to fully support this hypothesis.

Keywords: Adrenergic alpha-antagonists; Extracorporeal shock wave lithotripsy; Meta-analysis; Tamsulosin; Ureteral calculi.

FIG. 1

Search results: trial flow diagram. RCTs, randomized controlled trials; METs, medical expulsive therapy.

FIG. 2

Funnel plot of the included studies. SE (RD), standard error (risk differences).

FIG. 3

Forest plot of comparison: tamsulosin vs. control. CI, confidence interval.

FIG. 4

Forest plots grouped by stone locations. (A) Upper ureter stone. (B) Lower ureter stone. CI, confidence interval.

FIG. 5

Forest plots grouped by whether SWL was applied or not. (A) After SWL. (B) No SWL (expectant treatment). SWL, shock wave lithotripsy; CI, confidence interval.