He Feng, Man Li-Bo, Li Gui-Zhong, Liu Ning
Department of Urinary Surgery, Beijing Jishuitan Hospital, Beijing, People's Republic of China.
Drug Des Devel Ther. 2016 May 26;10:1783-93. doi: 10.2147/DDDT.S103195. eCollection 2016.
To critically evaluate the efficacy of an α-blocker in improving ureteral-stent-related symptoms and preliminarily investigate the difference between different types of α-blockers.
Relevant randomized controlled trials were identified through searching PubMed, the Cochrane Library, Embase, and other sources. After quality assessment and data abstraction, direct comparison based on the Ureteral Stent-related Symptom Questionnaire (USSQ) between α-blockers and control was performed by RevMan 5.3. Indirect comparison between different types of α-blockers was performed by ITC 1.0. Sensitive and subgroup analyses were used to handle important clinical factors.
Sixteen randomized controlled trials containing 1,489 cases were included. Compared with control, α-blockers significantly reduced the overall urinary symptom, pain index, general health index, and scores related to sexual matters, while no significant difference was found in work performance and additional problem scores. Subgroup analysis showed that the duration of stent insertion, patient's age, stent size, and the type of α-blocker had the potential to influence the outcomes. Through indirect comparison, we found alfuzosin and terazosin to be better than tamsulosin in pain relief and general health improvement.
α-Blocker was effective in treating ureteral stent-related symptoms, as it improved the major indexes of USSQ post-insertion or post-removal. Alfuzosin and terazosin seemed to be better than tamsulosin, which needs further verification because of the lack of direct comparison currently.
严格评估α受体阻滞剂改善输尿管支架相关症状的疗效，并初步探究不同类型α受体阻滞剂之间的差异。
通过检索PubMed、Cochrane图书馆、Embase及其他来源，确定相关随机对照试验。在进行质量评估和数据提取后，使用RevMan 5.3软件基于输尿管支架相关症状问卷（USSQ）对α受体阻滞剂与对照组进行直接比较。使用ITC 1.0软件对不同类型的α受体阻滞剂进行间接比较。采用敏感性分析和亚组分析来处理重要的临床因素。
纳入16项随机对照试验，共1489例患者。与对照组相比，α受体阻滞剂显著降低了总体泌尿系统症状、疼痛指数、总体健康指数以及与性相关问题的评分，而在工作表现评分和其他问题评分方面未发现显著差异。亚组分析表明，支架置入时间、患者年龄、支架尺寸以及α受体阻滞剂类型可能会影响结果。通过间接比较，我们发现阿夫唑嗪和特拉唑嗪在缓解疼痛和改善总体健康方面优于坦索罗辛。
α受体阻滞剂在治疗输尿管支架相关症状方面有效，因为它改善了输尿管支架置入后或取出后的USSQ主要指标。阿夫唑嗪和特拉唑嗪似乎优于坦索罗辛，但由于目前缺乏直接比较，这一结论有待进一步验证。
