Alpha blockers in the management of ureteric lithiasis: A meta-analysis

Raison, Nicholas; Ahmed, Kamran

doi:10.1111/ijcp.12917

Cited by 9 publications

(8 citation statements)

References 71 publications

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“…Interestingly, the meta-analysis by Raison and colleagues. 12 showed a greater benefit for MET in stone passage (RR = 1.60) for larger stones (>5 mm) in keeping with the Australian study published by Furyk and colleagues. 6 It also showed MET is also better at treating distal ureteric stones (RR = 1.50), in keeping with the study by Sur and colleagues, 7 but not in the study by Furyk and colleagues.…”

Section: Evidence Against Medical Expulsive Therapysupporting

confidence: 88%

Medical expulsive therapy for ureteric calculi – yes or no?

Williams

Dhanasekaran

2017

Journal of Clinical Urology

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Key papers on this topic were identified after reviewing the appropriate sections of the latest European Association Urology (EAU) and American Urology Association (AUA) urolithiasis guidelines. Key papers were also identified after they were discussed during lectures on MET at the recent EAU congress (London, 2017) and the American Urology Association (AUA) annual meeting (Boston, 2017). Evidence for medical expulsive therapy To date, the body of evidence used to answer this common clinical question over the last decade has been in the form of meta-analyses and systematic reviews. 1-4 Whilst the robustness of meta-analyses is often sufficient to answer the majority of clinical questions, they do have drawbacks. Many meta-analyses include poorly designed, non-randomised studies and the need for a well-designed randomised controlled trial (RCT) is the closing statement in many of these studies. Further limitations of the RCTs used in these meta-analyses include the variation of α-blockers used (including tamsulosin, alfuzosin and doxazosin, for example) and the variable use of followup imaging in the studies. Many of the included studies lacked a placebo-controlled arm (41 studies out of 55 in one meta-analysis), duration of follow up was variable (7-42 days) and MET was used in conjunction with corticosteroids in either the control or intervention group in three studies. Only six studies in the largest (55

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Section: Evidence Against Medical Expulsive Therapysupporting

confidence: 88%

Medical expulsive therapy for ureteric calculi – yes or no?

Williams

Dhanasekaran

2017

Journal of Clinical Urology

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“…Traditionally the expectant management is reserved only for renal stones smaller than 5 mm [ 7 ]. Recent studies have shown that medical expulsive therapy (MET) is efficacious in promoting stone expulsion and this effect is more prominent with larger stones [ 8 , 9 ]. Tamsulosin and nifedipine are the two main agents shown to be effective as MET [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Outcome of uncomplicated ureteric calculi managed with medical expulsive therapy in the outpatient clinic of a urology unit in Sri Lanka

et al. 2017

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ObjectiveAlthough medical expulsive therapy (MET) is shown to be effective for ureteric calculi, the optimum duration and the stone size suitable for MET are not well established yet. The objectives of the study were to determine the optimum duration and maximum stone size suitable for MET.ResultsAll patients with radiologically confirmed uncomplicated ureteric calculi treated with MET using tamsulosin over a period of 6 months in the outpatient setting were followed up. There were 213 patients. 165 were men. Mean age was 42 years. At presentation 42 stones were in upper ureter (19.7%), 51 in mid ureter (23.9%), 120 in lower ureter (56.3%). The majority (82.7%) of stones were less than 10 mm. Seven stones (3.3%) were over 15 mm. Ninety-two (43.2%) patients had spontaneous passage of stones within 6-weeks of MET. Another 38.9% passed the stone within the next 6-weeks. Thirty-eight patients (17.8%) required surgery. Uncomplicated ureteric stones up to 10 mm can be given a trial of MET using tamsulosin which can be extended up to 12-weeks with a success rate over 92%. This may have substantial clinical and fiscal benefits by reducing the number of interventional procedures especially in resource-poor settings.Electronic supplementary materialThe online version of this article (10.1186/s13104-017-2974-1) contains supplementary material, which is available to authorized users.

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“…As a bibliometric experiment, I made a list of all EC articles from 2016 to 2017, excluding editorials, and examined the number of downloads from the journal's website ascertained by Wiley as of 22 August 2018 (Table ). For the articles published in 2016 and 2017, I also compiled a list of the top 10 downloaded articles from the journal (Table ).…”

Section: Articles From the International Journal Of Clinical Practicementioning

confidence: 99%