title: The beneficial effect of alpha-blockers for ureteral stent-related discomfort: systematic review and network meta-analysis for alfuzosin versus tamsulosin versus placebo.
abstract: BACKGROUND
  This study was carried out a network meta-analysis of evidence from randomized controlled trials (RCTs) to evaluate stent-related discomfort in patients with alfuzosin or tamsulosin versus placebo.
  
  
  METHODS
  Relevant RCTs were identified from electronic databases. The proceedings of appropriate meetings were also searched. Seven articles on the basis of RCTs were included in our meta-analysis. Using pairwise and network meta-analyses, comparisons were made by qualitative and quantitative syntheses. Evaluation was performed with the Ureteric Stent Symptoms Questionnaire to assess the urinary symptom score (USS) and body pain score (BPS).
  
  
  RESULTS
  One of the seven RCTs was at moderate risk of bias for all quality criteria; two studies had a high risk of bias. In the network meta-analysis, both alfuzosin (mean difference [MD];-4.85, 95 % confidence interval [CI];-8.53--1.33) and tamsulosin (MD;-8.84, 95 % CI;-13.08--4.31) showed lower scores compared with placebo; however, the difference in USS for alfuzosin versus tamsulosin was not significant (MD; 3.99, 95 % CI;-1.23-9.04). Alfuzosin (MD;-5.71, 95 % CI;-11.32--0.52) and tamsulosin (MD;-7.77, 95 % CI;-13.68--2.14) showed lower scores for BPS compared with placebo; however, the MD between alfuzosin and tamsulosin was not significant (MD; 2.12, 95 % CI;-4.62-8.72). In the rank-probability test, tamsulosin ranked highest for USS and BPS, and alfuzosin was second.
  
  
  CONCLUSIONS
  The alpha-blockers significantly decreased USS and BPS in comparison with placebo. Tamsulosin might be more effective than alfuzosin.
authors.affiliation: Department of Urology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea. jkstorm@naver.com.
authors.forename: Jong Kyou
authors.initials: JK
authors.lastname: Kwon
authors.affiliation: Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea. kscho99@yuhs.ac.
authors.forename: Kang Su
authors.initials: KS
authors.lastname: Cho
authors.affiliation: Department of Urology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea. ckohuro@gmail.com.
authors.forename: Cheol Kyu
authors.initials: CK
authors.lastname: Oh
authors.affiliation: Department of Urology, Yangpyeong Health Center, Yangpyeong, South Korea. doudong14@gmail.com.
authors.forename: Dong Hyuk
authors.initials: DH
authors.lastname: Kang
authors.affiliation: Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention, Osong, South Korea. sea2sky@korea.kr.
authors.forename: Hyungmin
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. uroham@yuhs.ac.
authors.forename: Won Sik
authors.initials: WS
authors.lastname: Ham
authors.affiliation: Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. youngd74@yuhs.ac.
authors.forename: Young Deuk
authors.initials: YD
authors.lastname: Choi
authors.affiliation: Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. joouro@yuhs.ac.
authors.forename: Joo Yong
authors.initials: JY
authors.lastname: Lee
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage*; D001499:Bayes Theorem; D006801:Humans; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D011799:Quinazolines / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D015607:Stents / Q000009:adverse effects*; D013449:Sulfonamides / Q000008:administration & dosage*; D000077409:Tamsulosin; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000628:therapy
chemical_list: D000317:Adrenergic alpha-Antagonists; D011799:Quinazolines; D013449:Sulfonamides; C047638:alfuzosin; D000077409:Tamsulosin