The efficacy and safety of alpha-adrenergic blockers for medical expulsion therapy in patients with ureteral calculi: A meta-analysis of placebo-controlled trials.

Abstract

PURPOSE:

Alpha-adrenergic blockers are commonly used as a medical expulsive therapy (MET) for patients with ureteral calculi. The aim of this meta-analysis was to evaluate the efficacy and safety of alpha-adrenergic blockers compared with a placebo when used as a MET.

MATERIALS AND METHODS:

We carried out a systematic search of the PubMed, EMBASE, and Web of Science databases, and the Cochrane Library, for relevant articles from inception to November 2020. Our aim was to identify placebo-controlled trails in which patients were randomized to receive either alpha-adrenergic blockers (tamsulosin, alfuzosin, doxazosin, terazosin, naftopidil, or silodosin) or a placebo for the treatment of ureteral calculi.

RESULTS:

According to strict inclusion criteria, database searches identified 8 placebo-controlled studies that included 2284 patients. Generally, α-blockers had no significant effect on the clearance of stones in the urinary tract (risk ratio [RR] = 1.05; 95% confidence interval [CI] = 1.00-1.11). However, subgroup analysis showed that α-blockers were effective in treating distal urinary tract stones (RR = 1.08; 95% CI = 1.02-1.15). With regards to adverse events, our analysis showed that the combination of MET with α-blockers was likely to cause dizziness (RR = 1.37; 95% CI = 1.06-1.79) and retrograde ejaculation (RR = 3.10; 95% CI = 1.81-5.29).

CONCLUSION:

Although α-blockers cannot improve the overall ureteral stone clearance rate, these drugs are still effective for the treatment of stones in the distal urinary tract. However, the application of α-blockers is likely to cause dizziness and/or retrograde ejaculation.

• Authors: Ze-Wei Yu, Rui-Hong Wang, Chang-Cun Zhang, Jian-Gang Gao
• Journal: Medicine (Medicine (Baltimore)) Vol. 100 Issue 37 Pg. e27272 (Sep 17 2021) ISSN: 1536-5964 [Electronic] United States
• PMID: 34664882 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

Chemical References

• Adrenergic alpha-Antagonists
• Placebos

Topics

• Adrenergic alpha-Antagonists (pharmacology, therapeutic use)
• Humans
• Odds Ratio
• Placebos
• Treatment Outcome
• Ureteral Calculi (drug therapy)