The Efficacy and Safety of Tamsulosin Combined with Extracorporeal Shockwave Lithotripsy for Urolithiasis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
OBJECTIVE
Many studies have been conducted to investigate adjunctive tamsulosin therapy after extracorporeal shockwave lithotripsy (SWL) for urolithiasis. The results from those studies, however, are still inconsistent. Therefore, we performed a meta-analysis to provide an update on the clinical efficacy and safety of tamsulosin combined with SWL for urolithiasis.


METHODS
A systematic search was performed in PubMed, Cochrane Library, and Embase to identify all relevant randomized controlled trials until January 2015. Two reviewers independently assessed trial quality and extracted data. Meta-analysis was conducted with Review Manager (RevMan), version 5.1.


RESULTS
Twenty-one studies (2093 subjects in total) were identified in the current meta-analysis. Compared with a control group, the experimental group (tamsulosin combined with SWL) showed an increased overall benefit for stone expulsion, with pooled risk ratio (RR) of 1.20 (95% confidence interval [CI], 1.15-1.26). With respect to the different geographic regions, European and American had a high possibility of improvement in stone expulsion (RR: 1.33, 95% CI, 1.19-1.49). According to the stone locations (renal, upper and lower ureteral) and sizes (4-10 mm and 11-24 mm), tamsulosin is more useful for lower ureteral stone (RR: 1.28; 95% CI, 1.14-1.43) and larger sized stones (RR: 1.49; 95% CI, 1.28-1.75). The effect estimates did not vary markedly when stratified by follow-up durations but varied by dose of tamsulosin. Furthermore, a shorter expulsion time, reduced occurrence of steinstrasse, fewer incidences of colic, and lower analgesic requirements were observed within the experimental group. In addition, tamsulosin is well tolerated, and its adverse events rarely led to dropouts of patients.


CONCLUSIONS
Overall, evidence suggests that tamsulosin combined with SWL is safe and effective in enhancing stone expulsion for patients with urolithiasis. Furthermore, high-quality, randomized and placebo-controlled trials evaluating the efficacy and safety of tamsulosin should be performed.
1 Department of Urology, The People's Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College , Shandong Province, China .
Kai
K
Chen
2 Institute of Urology and Nephrology, First Affiliated Hospital of Guangxi Medical University , Nanning, Guangxi Zhuang Autonomous Region, China .
Hua
H
Mi
1 Department of Urology, The People's Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College , Shandong Province, China .
Guangyu
G
Xu
3 Department of Oncology, The People's Hospital of AnQiu City , Shandong Province, China.
Lin
L
Liu
1 Department of Urology, The People's Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College , Shandong Province, China .
Xiubin
X
Sun
1 Department of Urology, The People's Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College , Shandong Province, China .
Shiping
S
Wang
1 Department of Urology, The People's Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College , Shandong Province, China .
Qingrong
Q
Meng
1 Department of Urology, The People's Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College , Shandong Province, China .
Tao
T
Lv
D003131:Combined Modality Therapy; D006801:Humans; D008096:Lithotripsy / Q000379:methods*; D061214:Patient Safety; D016032:Randomized Controlled Trials as Topic; D013449:Sulfonamides / Q000627:therapeutic use*; D000077409:Tamsulosin; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000628:therapy*; D052878:Urolithiasis / Q000628:therapy*; D064804:Urological Agents / Q000627:therapeutic use
D013449:Sulfonamides; D064804:Urological Agents; D000077409:Tamsulosin