Parsons J Kellogg, Hergan Lori Ann, Sakamoto Kyoko, Lakin Charles
Division of Urology, University of California San Diego School of Medicine, San Diego, California 92103, USA.
J Urol. 2007 Mar;177(3):983-7; discussion 987. doi: 10.1016/j.juro.2006.10.023.
We determined if alpha-blocker therapy promotes expulsion of ureteral stones.
Meta-analysis was performed of randomized clinical trials of alpha-blockers for the treatment of ureteral stones. The primary outcome was overall stone expulsion rate. Risk ratios and risk differences were estimated using DerSimonian and Laird random effects models.
Eleven trials (911 participants) met inclusion criteria for this study. Pooled analysis demonstrated significantly increased rates of stone expulsion with alpha-blocker therapy. Compared to patients receiving conservative therapy only, patients receiving conservative therapy plus alpha-blockers were 44% more likely to spontaneously expel the stones (RR 1.44, 95% CI 1.31 to 1.59, p<0.001), and stone expulsion incidence increased significantly (RD 0.28, 95% CI 0.22 to 0.34, p<0.001). Sensitivity and subgroup analyses categorized by specific alpha-blocker, prior use of shock wave lithotripsy and stone size produced similar effect estimates, but were generally less precise due to smaller sample sizes. The largest subgroup of trials (664 participants) studied tamsulosin without prior shock wave lithotripsy (RR 1.44, 95% CI 1.32 to 1.58; RD 0.29, 95% CI 0.23 to 0.35).
alpha-Blocker therapy is associated with significantly increased rates of distal ureteral stone expulsion.
我们确定α受体阻滞剂疗法是否能促进输尿管结石排出。
对α受体阻滞剂治疗输尿管结石的随机临床试验进行荟萃分析。主要结局是总体结石排出率。采用DerSimonian和Laird随机效应模型估计风险比和风险差异。
11项试验（911名参与者）符合本研究的纳入标准。汇总分析表明，α受体阻滞剂疗法显著提高了结石排出率。与仅接受保守治疗的患者相比，接受保守治疗加α受体阻滞剂的患者自发排出结石的可能性高44%（风险比1.44，95%置信区间1.31至1.59，p<0.001），结石排出发生率显著增加（风险差异0.28，95%置信区间0.22至0.34，p<0.001）。按特定α受体阻滞剂、既往是否使用冲击波碎石术和结石大小进行的敏感性和亚组分析产生了相似的效应估计值，但由于样本量较小，通常不太精确。最大的试验亚组（664名参与者）研究了未接受过冲击波碎石术的坦索罗辛（风险比1.44，95%置信区间1.32至1.58；风险差异0.29，95%置信区间0.23至0.35）。
α受体阻滞剂疗法与远端输尿管结石排出率显著增加相关。
