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

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

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 andP = 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.

Journal Article, Review
2090-598X
83-93
Amer, Tarik
34b3aacc-a0bb-4f35-ae65-6808574e6c1f
Osman, Banan
8bdfb1e4-8524-476b-b490-e50275b170e4
Johnstone, Allan
d61f6865-7fc2-4879-b6a2-070ee9eeda13
Mariappan, Martin
ad5145b5-3f6c-4b09-a2bf-f73384ebfa89
Gupta, Ameet
80e4feee-b734-42bb-97a2-8351a068eb65
Brattis, Nikolaos
d4fe1ac0-9273-4583-b745-99f7c434c24c
Jones, Gareth
ffe8ce54-bf80-45f0-a4d2-5b36e270d1a6
Somani, Bhaskar K.
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Keeley, Francis X.
e30d551e-62ac-4e01-bedd-e0e50aaa69c7
Aboumarzouk, Omar M.
3c7e2433-638d-4378-9931-902fdc68acce
Amer, Tarik
34b3aacc-a0bb-4f35-ae65-6808574e6c1f
Osman, Banan
8bdfb1e4-8524-476b-b490-e50275b170e4
Johnstone, Allan
d61f6865-7fc2-4879-b6a2-070ee9eeda13
Mariappan, Martin
ad5145b5-3f6c-4b09-a2bf-f73384ebfa89
Gupta, Ameet
80e4feee-b734-42bb-97a2-8351a068eb65
Brattis, Nikolaos
d4fe1ac0-9273-4583-b745-99f7c434c24c
Jones, Gareth
ffe8ce54-bf80-45f0-a4d2-5b36e270d1a6
Somani, Bhaskar K.
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Keeley, Francis X.
e30d551e-62ac-4e01-bedd-e0e50aaa69c7
Aboumarzouk, Omar M.
3c7e2433-638d-4378-9931-902fdc68acce

Amer, Tarik, Osman, Banan, Johnstone, Allan, Mariappan, Martin, Gupta, Ameet, Brattis, Nikolaos, Jones, Gareth, Somani, Bhaskar K., Keeley, Francis X. and Aboumarzouk, Omar M. (2017) Medical expulsive therapy for ureteric stones: analysing the evidence from systematic reviews and meta-analysis of powered double-blinded randomised controlled trials. Arab Journal of Urology, 15 (2), 83-93. (doi:10.1016/j.aju.2017.03.005).

Record type: Review

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 andP = 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.

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More information

Accepted/In Press date: 27 March 2017
e-pub ahead of print date: 18 April 2017
Published date: 1 June 2017
Keywords: Journal Article, Review

Identifiers

Local EPrints ID: 418994
URI: https://eprints.soton.ac.uk/id/eprint/418994
ISSN: 2090-598X
PURE UUID: 0c709baf-2a0d-438a-9b68-aeb89d22db18

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Date deposited: 27 Mar 2018 16:30
Last modified: 18 Jul 2019 17:31

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