Cao Dehong, Yang Lu, Liu Liangren, Yuan Haichao, Qian Shenqiang, Lv Xiao, Han Pin, Wei Qiang
From the Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Sci Rep. 2014 Jun 11;4:5254. doi: 10.1038/srep05254.
Administration of nifedipine or tamsulosin has been suggested to augment stone expulsion rates. We aimed to compare the stone expulsion rates and adverse effects associated with the use of nifedipine or tamsulosin as medical expulsive therapy (MET) for the management of lower ureteral stones (LUS) without extracorporeal shock wave lithotripsy (ESWL) via a literature review and meta-analysis. Relevant randomized controlled trials (RCTs) were identified from the Medline, EMBASE, Cochrane CENTRAL, and Google Scholar databases. Finally, a total of 7 RCTs with 3897 patients were included. Our meta-analysis showed that tamsulosin could significantly increase the stone expulsion rate relative to nifedipine in patients with LUS (random-effects model; risk ratio [RR] = 0.81; 95% confidence interval [CI] = 0.75-0.88; P < 0.00001). The subgroup analysis indicated no statistically significant difference between the drugs with regard to minor or major adverse effects (fixed-effect model; RR = 1.19, 95% CI = 0.91-1.54, P = 0.20; and RR = 1.63, 95% CI = 0.22-11.82, P = 0.63, respectively). This meta-analysis demonstrated that tamsulosin was more effective than nifedipine in patients with LUS, as evidenced by the higher stone expulsion rate. Tamsulosin treatment should therefore be considered for patients with LUS.
有人建议使用硝苯地平或坦索罗辛来提高结石排出率。我们旨在通过文献综述和荟萃分析，比较在不进行体外冲击波碎石术（ESWL）的情况下，使用硝苯地平或坦索罗辛作为药物排石疗法（MET）治疗输尿管下段结石（LUS）的结石排出率和不良反应。从Medline、EMBASE、Cochrane CENTRAL和谷歌学术数据库中检索相关的随机对照试验（RCT）。最终，共纳入了7项RCT，涉及3897例患者。我们的荟萃分析表明，对于LUS患者，坦索罗辛相对于硝苯地平可显著提高结石排出率（随机效应模型；风险比[RR]=0.81；95%置信区间[CI]=0.75-0.88；P<0.00001）。亚组分析表明，在轻微或严重不良反应方面，两种药物之间无统计学显著差异（固定效应模型；RR=1.19，95%CI=0.91-1.54，P=0.20；以及RR=1.63，95%CI=0.22-11.82，P=0.63）。该荟萃分析表明，坦索罗辛在LUS患者中比硝苯地平更有效，结石排出率更高即为证据。因此，对于LUS患者应考虑使用坦索罗辛治疗。
