Comparative efficacy of tamsulosin versus nifedipine for distal ureteral calculi: a meta-analysis.
OBJECTIVE
The aim of this study was to systematically compare the therapeutic effect and safety of tamsulosin with nifedipine in medical expulsive therapy for distal ureteral calculi.


METHODS
Databases, including PubMed, EMBASE, the Cochrane Library, and Clinical Trial Register Centers, were comprehensively searched. Relevant randomized controlled trials (RCTs) were selected, and quality assessment was performed according to the Cochrane Handbook. RevMan software was used to analyze the outcome measures, which consisted of expulsion rate, expulsion time, and complications.


RESULTS
Twelve RCTs consisting of 4,961 patients were included (tamsulosin group, 2,489 cases; nifedipine group, 2,472 cases). Compared with nifedipine, tamsulosin significantly increased the expulsion rate (risk ratio =1.29, 95% CI [1.25, 1.33], P<0.0001) and reduced the expulsion time (standard mean difference =-0.39, 95% CI [-0.72, -0.05], P=0.02). Regarding safety, tamsulosin was associated with fewer complications than nifedipine (risk ratio =0.45, 95% CI [0.28, 0.72], P=0.0008), and further subgroup analysis showed that tamsulosin was associated with a lower risk of both mild and moderate-to-severe complications.


CONCLUSIONS
On the bias of current evidence, tamsulosin showed an overall superiority to nifedipine for distal ureteral calculi <10 mm in aspects of expulsion rate, expulsion time, and safety. Tamsulosin was supposed to be the first drug to be recommended to patients willing to receive medical expulsive therapy.
Department of Urology, Beijing Jishuitan Hospital, Beijing, People's Republic of China.
Hai
H
Wang
Department of Urology, Beijing Jishuitan Hospital, Beijing, People's Republic of China.
Li Bo
LB
Man
Department of Urology, Beijing Jishuitan Hospital, Beijing, People's Republic of China.
Guang Lin
GL
Huang
Department of Urology, Beijing Jishuitan Hospital, Beijing, People's Republic of China.
Gui Zhong
GZ
Li
Department of Urology, Beijing Jishuitan Hospital, Beijing, People's Republic of China.
Jian Wei
JW
Wang
D006801:Humans; D009543:Nifedipine / Q000627:therapeutic use*; D013449:Sulfonamides / Q000627:therapeutic use*; D000077409:Tamsulosin; D014514:Ureteral Calculi / Q000188:drug therapy*
D013449:Sulfonamides; D000077409:Tamsulosin; D009543:Nifedipine
MET; lower urinary calculi; medical expulsive therapy; nifedipine; tamsulosin