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Review
. 2017 Apr 18;15(2):83-93.
doi: 10.1016/j.aju.2017.03.005. eCollection 2017 Jun.

Medical expulsive therapy for ureteric stones: Analysing the evidence from systematic reviews and meta-analysis of powered double-blinded randomised controlled trials

Tarik Amer  1 , Banan Osman  2 , Allan Johnstone  1 , Martin Mariappan  1 , Ameet Gupta  3 , Nikolaos Brattis  2 , Gareth Jones  1 , Bhaskar K Somani  4 , Francis X Keeley Jr  2 , Omar M Aboumarzouk  1   2   5   6
Affiliations
Review

Medical expulsive therapy for ureteric stones: Analysing the evidence from systematic reviews and meta-analysis of powered double-blinded randomised controlled trials

Tarik Amer et al. Arab J Urol. .

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

Keywords: ARR, absolute risk reduction; CCB, calcium channel blocker; Calcium channel blockers; MD, mean difference; MET, medical expulsive therapy; MeSH, medical subject headings; Medical expulsive therapy (MET); NNT, numbers needed to treat; RCT, randomised controlled trial; RR, risk ratio; RoB, risk of bias; Ureteric stones; Urinary stones; α-Blockers.

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Figures

Fig. 1
Fig. 1
Flowchart for article selection process of the review.
Fig. 2
Fig. 2
MET overall expulsion rates.
Fig. 3
Fig. 3
MET secondary outcomes.
Fig. 3
Fig. 3
MET secondary outcomes.
Fig. 4
Fig. 4
RoB table.
See this image and copyright information in PMC

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