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Tamsulosin for treatment of unilateral distal ureterolithiasis: a systematic review and metaanalysis

Published online by Cambridge University Press:  04 March 2015

Christian Malo ,
Jean-Sébastien Audette-Côté ,
Marcel Émond  and
Alexis F. Turgeon
Christian Malo*
Affiliation:
Department of Family and Emergency Medicine, Université Laval, Québec City, QC
Jean-Sébastien Audette-Côté
Affiliation:
Department of Family and Emergency Medicine, Université Laval, Québec City, QC
Marcel Émond
Affiliation:
Department of Family and Emergency Medicine, Université Laval, Québec City, QC Axe de recherche en Traumatologie - Urgence - Soins intensifs, School of Public Health, Centre de recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Québec City, QC
Alexis F. Turgeon
Affiliation:
Axe de recherche en Traumatologie - Urgence - Soins intensifs, School of Public Health, Centre de recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Québec City, QC Division of Critical Care Medicine, Department of Anesthesiology, Université LavalQuébec City, QC
*
Axe de recherche en Traumatologie-Urgence-Soins intensifs, Centre de recherche du CHU de Québec, Hôpital Enfant-Jésus, 1401, 18iéme rue, Québec, QC G1J 1Z4; christian.malo.1@ulaval.ca

Abstract

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Objectives:

The lifetime prevalence of ureterolithiasis is approximately 13% for men and 7% for women in the United States. Tamsulosin, an α-antagonist, has been used as therapy to facilitate the expulsion of lithiasis. Whether it is a good treatment for distal lithiasis remains controversial. We conducted a systematic review and meta-analysis to evaluate the effect of tamsulosin on the passage of distal ureterolithiasis.

Methods:

A systematic search was conducted using MEDLINE, EMBASE, and Cochrane Central. Trial eligibility was evaluated by two investigators. All randomized controlled trials (RCTs) comparing tamsulosin to standard therapy or placebo for the treatment of a single distal ureterolithiasis ≤ 10 mm in adult patients with renal colic confirmed by radiographic imaging were included. Data extraction was conducted in duplicate. Primary outcome was the expulsion rate, and secondary outcomes were the mean time for ureterolithiasis expulsion, analgesic requirements, and side effects. Mantel-Haenszel random effect models were used, and heterogeneity was assessed using I2 statistics. Data were presented with relative risks (RRs).

Results:

The search strategy identified 685 articles, of which 22 studies were included. Combined results suggested a benefit for the expulsion of ureterolithiasis (≥ 10 mm) when tamsulosin was used compared to a standard treatment (RR 1.50 [95% CI 1.31–1.71], I2 = 70%). A decrease in the average time of expulsion of the ureterolithiasis of 3.33 days in favour of tamsulosin was observed (95% CI −4.23, −2.44], I2 = 67%).

Conclusion:

Tamsulosin increases the rate of spontaneous passage of distal ureterolithiasis (≤ 10 mm).

Keywords

αantagonistα-blockernephrolithiasisrenal colictamsulosinureterolithiasis
Type
State of the Art • À la fine pointe
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 3 , May 2014 , pp. 229 - 242
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

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