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Meta-Analysis
. 2017 Mar;58(2):82-89.
doi: 10.4111/icu.2017.58.2.82. Epub 2017 Feb 2.

Efficacy of phosphodiesterase type 5 inhibitors for the treatment of distal ureteral calculi: A systematic review and meta-analysis

Carlos Eduardo Montes Cardona  1 , Herney Andrés García-Perdomo  1
Affiliations
Meta-Analysis

Efficacy of phosphodiesterase type 5 inhibitors for the treatment of distal ureteral calculi: A systematic review and meta-analysis

Carlos Eduardo Montes Cardona et al. Investig Clin Urol. 2017 Mar.

Abstract

Purpose: To determine the efficacy of phosphodiesterase type 5 inhibitors (PDE5i) as medical expulsive therapy (MET) for the treatment of distal ureteral calculi.

Materials and methods: A search strategy was conducted in the MEDLINE, CENTRAL, and Embase databases. Searches were also conducted in other databases and unpublished literature. Clinical trials were included without language restrictions. The risk of bias was evaluated with the Cochrane Collaboration's tool. An analysis of random effects due to statistical heterogeneity was conducted. The primary outcome was the expulsion rate of the distal ureteral calculus in 28 days. The secondary outcomes were the time to expulsion, side effects of treatment, and amount (mg) of nonopioid analgesia. The measure of the effect was the risk difference (RD) with a 95% confidence interval (CI). The planned interventions were PDE5i vs. placebo, tadalafil vs. placebo, and tadalafil vs. tamsulosin.

Results: Four articles were included in the qualitative and quantitative analysis. Records of 580 patients were found among the four studies. A low risk of bias was shown for the majority of the study items. The calculi expulsion rate had an RD of 0.26 (95% CI, 0.15-0.37) and a less prolonged expulsion as a secondary outcome with a mean difference of -4.39 days (95% CI, -6.69 to -2.09) in favor of PDE5i compared with the placebo. No significant difference was found for these outcomes when comparing tadalafil with tamsulosin.

Conclusions: Compared with a placebo, PDE5i could be effective as MET for the treatment of distal ureter calculi.

Keywords: Meta-analysis; Phosphodiesterase 5 inhibitors; Review; Ureteral calculi.

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Conflict of interest statement

CONFLICTS OF INTEREST: The authors have nothing to disclose.

Figures

Fig. 1
Fig. 1. Flowchart. RCT, randomized clinical trial.
Fig. 2
Fig. 2. Risk of bias. (A) Within studies. (B) Among studies.
Fig. 3
Fig. 3. (A) Phosphodiesterase type 5 inhibitors (PDE5i) versus placebo: calculus expulsion rate. (B) PDE5i versus placebo: time to expulsion. df, degrees of freedom; CI, confidence interval.
Fig. 4
Fig. 4. Tadalafil versus tamsulosin: calculus expulsion rate. df, degrees of freedom; CI, confidence interval.
See this image and copyright information in PMC

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