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

Campschroer, Thijs; Zhu, Xiaoye; Vernooij, Robin W.M.; Lock, Tycho

doi:10.1111/bju.14454

Cited by 30 publications

(20 citation statements)

References 74 publications

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“…Medical expulsive therapy (MET), including diuretics, Chinese patent medicine and α receptor blockers (tamsulosin), have been used as auxiliary method to improve SFR following lithotripsy [16]. However, the medicine effect of tamsulosin in dilating ureter and facilitating stone fragments passage is controversial [17][18][19], as well as other medicines.…”

Section: Introductionmentioning

confidence: 99%

Is physical therapy effective following extracorporeal shockwave lithotripsy and retrograde intrarenal surgery: a meta-analysis and systematic review

Peng

Wen

Zhong³

et al. 2020

Preprint

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Objective: Physical therapy, including percussion, inversion, vibration and combinations, was clinically performed to improve the stone free rate (SFR) following lithotripsy procedures. However, physical therapy is not widely accepted in clinical practice owing to lack of high level evidence support and a standard protocol. The present meta-analysis aimed to evaluate the efficacy and safety of physical therapy in improving SFR following extracorporeal shockwave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS).Methods: Systematic review of literature from PubMed, Scopus, Cochrane library and Embase was performed in March 2019. The efficacy and safety of physical therapy after ESWL and RIRS were assessed by meta-analysis of SFR and complication rate.Results: A total of 8 prospective studies with 1065 patients were enrolled. When compared to non-intervention, physical therapy provided a higher SFR (OR:3.38, 95% CI: 2.45-4.66, p< 0.0001) at all time points (week 1, week 2 and month 1), while there was no significant difference in complications such as hematuria, lumbago, dizziness and urinary tract infection(OR: 0.84; 95%CI: 0.62-1.13; p=0.237). In subgroup analysis of different stone locations, lower calyx stone (OR: 3.51; 95%CI: 2.21-5.55; p<0.0001), upper ureter and renal pelvic stones (OR:2.79; 95%CI:1.62-4.81; p=0.0002) had a higher SFR after physical therapy, while there was no significant improvement in SFR in upper and middle calyx stones. In subgroup analysis of different techniques, EPVL (external physical vibration lithecbole, OR:3.47; 95%CI:2.24-5.37; p<0.0001) and PDI (percussion, diuresis and inversion, OR:3.24; 95%CI:2.01-5.21; p<0.0001) were both effective in improving SFR when compared to non-intervention. Conclusions: Physical therapy is effective in improving the SFR after ESWL and RIRS, especially for lower calyx stones, upper ureter and renal pelvic stones, while without significant side effects. External physical vibration lithecbole (EPVL) might provide a relative uniformed and repeatable protocol for clinical practice of physical therapy. Review Registration: PROSPERO 2019 CRD42019130228.

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Section: Introductionmentioning

confidence: 99%

Is physical therapy effective following extracorporeal shockwave lithotripsy and retrograde intrarenal surgery: a meta-analysis and systematic review

Peng

Wen

Zhong³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…The systematic review discussed here is an update of a 2014 Cochrane review. 6 It includes several new, large, RCTs.…”

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confidence: 99%

“…Further analyses examined only high-quality studies, excluding studies at high risk of bias. 6 Overall, the use of alpha blockers was associated with increased stone passage (relative risk [RR] = 1.45, 95% confidence interval [CI] = 1.36 to 1.55, absolute risk difference [ARD] = 28%, number needed to treat [NNT] = 4, low-quality evidence) without increasing the risk of major adverse events. Alpha blockers were also associated with a lower risk of hospitalization (RR = 0.51, 95% CI = 0.34 to 0.77, ARD = 14%, NNT = 7, moderate-quality evidence) and no difference in the risk of surgical intervention (low-quality evidence).…”

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confidence: 99%

“…The subgroup analysis based on the size of the stone revealed that alpha blockers did not impact passing of stones ≤ 5 mm but did improve passing of stones > 5 mm (RR = 1.45, 95% CI = 1.22 to 1.72, ARD = 30%, NNT = 3, moderate-quality evidence). 6 When the analysis was performed using high-quality trials only, alpha blockers increased stone passing (RR = 1.09, 95% CI = 1.06 to 1.13; ARD = 7%, NNT = 15, high-quality evidence, five studies, 4,133 participants) while having no effect on major adverse events, hospitalization, or surgical intervention. 6…”

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confidence: 99%

“…6 When the analysis was performed using high-quality trials only, alpha blockers increased stone passing (RR = 1.09, 95% CI = 1.06 to 1.13; ARD = 7%, NNT = 15, high-quality evidence, five studies, 4,133 participants) while having no effect on major adverse events, hospitalization, or surgical intervention. 6…”

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confidence: 99%

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