Treatment of ureteral lithiasis with tamsulosin: literature review and meta-analysis.
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 alpha-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.


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 chi(2) test.


RESULTS
Group 1 reported 19 stone expulsions (54.3%) and group 2 30 expulsions [85.7%, chi(2) = 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%, chi(2) = 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.
Arrabal-Martin
Miguel
M
Department of Urology, San Cecilio University Hospital, Granada, Spain. arrabalm@ono.com
Valle-Diaz de la Guardia
Francisco
F
Arrabal-Polo
Miguel Angel
MA
Palao-Yago
Francisco
F
Mijan-Ortiz
Jose Luis
JL
Zuluaga-Gomez
Armando
A
D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D006801:Humans; D011446:Prospective Studies; D013449:Sulfonamides / Q000627:therapeutic use*; D000077409:Tamsulosin; D053039:Ureterolithiasis / Q000188:drug therapy*
D000317:Adrenergic alpha-Antagonists; D013449:Sulfonamides; D000077409:Tamsulosin