Treatment of Ureteral Lithiasis with Tamsulosin: Literature Review and Meta-Analysis

Abstract

Objective: Ninety percent of ureteral calculi <4 mm are expelled over a period of 3 months; if they are >6 mm the elimination possibilities are reduced to 30%. Presently, investigations in the treatment of ureteral lithiasis have the objective of modifying ureter contractibility with the aid of calcium antagonist and α-blocking drugs. The objective of this study is to analyze the effect of tamsulosin in the treatment of the distal ureter lithiasis and to make a systematic analysis of the literature. Patients and Methods: In a prospective study 70 cases of distal ureter lithiasis were divided into 2 groups: group 1 = 35 cases treated with ibuprofen (600 mg/12 h) and 2,000 ml water/24 h with tramadol on demand, and group 2 = 35 cases with the same treatment as described before plus tamsulosin 0.4 mg/day over 3 weeks. The number of stone-free patients, time to expulsion and the necessity for analgesia were evaluated. A literature review (2002–2007) and meta-analysis of 11 studies was performed. Statistical analysis included relative risk (RR), number needed to treat (NNT) and χ² test. Results: Group 1 reported 19 stone expulsions (54.3%) and group 2 30 expulsions [85.7%, χ² = 8.23 (p < 0.01), RR = 1.58, NNT = 3 (95% CI 2–9)]. The mean time to expulsion was 14 days in group 1 and 8 days in group 2. No side effects were detected. Meta-analysis included 792 patients: 392 patients in group 1 and 400 patients in group 2. Group 1 reported 211 stone expulsions (53.8%) and group 2 reported 332 expulsions [83%, χ² = 78.17 (p < 0.01), RR = 1.54, absolute benefit = 29.2% (95% CI 23–35.3%), NNT = 3 (95% CI 3–4)]. The mean time to expulsion was 9.45 days in group 1 and 6.07 days in group 2 treated with tamsulosin; a significant difference was observed in all studies. Conclusions: Tamsulosin increases the elimination of distal ureter lithiasis of <10 mm.

α‐blockers as medical expulsive therapy for ureteric stones: a Cochrane systematic review

“…In total, 67 studies were included in our review (Appendix S2). Most studies (52 of 67) compared α‐blockers with standard therapy (i.e.…”

Tamsulosin for treatment of unilateral distal ureterolithiasis: a systematic review and metaanalysis

“…Only 4 studies had a low risk of bias, 14,27,33,36 7 had a moderate risk of bias, 24,25,30,32,34,35,38,40 and 11 had a high risk of bias 23,26,28,29,31,37,39,[41][42][43] (Figure 2). A poor description of the randomization process is mainly responsible for the high proportion of moderate or high risk of bias studies.…”

“…Studies were written in English 14,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] and Korean. 42,43 Most articles compared tamsulosin to standard therapy alone (NSAIDs + hydration 6 opioids).…”

“…42,43 Most articles compared tamsulosin to standard therapy alone (NSAIDs + hydration 6 opioids). [24][25][26][27][28][29][35][36][37][38][39][40][41][42][43] Seven…”

Role of combined use of potassium citrate and tamsulosin in the management of uric acid distal ureteral calculi

“…Patients with larger stones (5-10 mm) have a lower rate for spontaneous expulsion (25-53%) [3]. However, the use of alpha blockers or calcium channel blockers has been found to augment the passage of these calculi [4][5][6][7][8][9]. On the other hand, the minimally invasive therapies as extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) have been widely introduced for management of the distal ureteral calculi.…”