Medical Expulsive Therapy for Pediatric Ureteral Stones: A Meta-Analysis of Randomized Clinical Trials

Abstract

To evaluate the efficacy and safety of medical expulsive therapy (MET) for ureteral stones in pediatric patients, Cochrane, PubMed, Web of Science, Scopus, and the reference list of retrieved studies were searched up to September 2022 to identify RCTs on the efficacy of MET. The protocol was prospectively registered at PROSPERO (CRD42022339093). Articles were reviewed, data were extracted by two reviewers, and the differences were resolved by the third reviewer. The risk of bias was assessed using the RoB2. The outcomes, including the stone expulsion rate (SER), stone expulsion time (SET), episode of pain, analgesic consumption, and adverse effects, were evaluated. Six RCTs enrolling 415 patients were included in the meta-analysis. The duration of MET ranged from 19 to 28 days. The investigated medications included tamsulosin, silodosin, and doxazosin. The stone-free rate after 4 weeks in the MET group was 1.42 times that of the control group (RR: 1.42; 95% CI: 1.26–1.61, p < 0.001). The stone expulsion time also decreased by an average of 5.18 days (95% CI: −8.46/−1.89, p = 0.002). Adverse effects were more commonly observed in the MET group (RR: 2.18; 95% CI: 1.28–3.69, p = 0.004). The subgroup analysis evaluating the influence of the type of medication, the stone size, and the age of patients failed to reveal any impact of the aforementioned factors on the stone expulsion rate or stone expulsion time. Alpha-blockers as medical expulsive therapy among pediatric patients are efficient and safe. They increase the stone expulsion rate and decrease the stone expulsion time; however, this included a higher rate of adverse effects, which include headache, dizziness, or nasal congestion.

Epidemilogic, Diagnostic, and Therapeutic Features of Urinary Stone Disease in Nothern Benin from 2018 to 2023

“…We could not evaluate the expulsion rate of ureteral stone treated with alpha-blocker. Yet the efficacy of alpha-blockers as a medical expulsive therapy for ureteral stones have been demonstrated [35] [36] [37].…”

Management of Pediatric Urolithiasis in an Italian Tertiary Referral Center: A Retrospective Analysis

“…A blockade of α1-adrenoreceptors (mainly subtype D) inhibits hyperperistaltic uncoordinated frequency while preserving ureteral tonic propulsive contractions, producing lumen dilation and possible stone elimination [36]. As a result, evidence supports the use of α-blockers as a medical expulsive therapy (MET) in adults, but the literature relating to children is limited [37]. Different previous studies already proved the safety of these drugs for children's voiding dysfunction.…”

The Efficacy of Preoperative Tamsulosin on Ureteroscopy Access in Pediatrics: A Systematic Review and Meta-Analysis

“…14 According to meta analysis from Ziaeefar, using medical compulsive therapy (MET) enhances stone expulsive rate while decreasing stone expulsive time. 15 The use of alpha-blockers such as tamsulosin is generally used for medical compulsive treatment (MET) of distal ureteral stones in adults and children. 1 Alpha-1 adrenergic receptors are the most common adrenoceptors in prostate and bladder neck tissue.…”