Department of Urology, Universidad del Valle, Cali, Colombia.
Investig Clin Urol. 2017 Mar;58(2):82-89. doi: 10.4111/icu.2017.58.2.82. Epub 2017 Feb 2.
To determine the efficacy of phosphodiesterase type 5 inhibitors (PDE5i) as medical expulsive therapy (MET) for the treatment of distal ureteral calculi.
A search strategy was conducted in the MEDLINE, CENTRAL, and Embase databases. Searches were also conducted in other databases and unpublished literature. Clinical trials were included without language restrictions. The risk of bias was evaluated with the Cochrane Collaboration's tool. An analysis of random effects due to statistical heterogeneity was conducted. The primary outcome was the expulsion rate of the distal ureteral calculus in 28 days. The secondary outcomes were the time to expulsion, side effects of treatment, and amount (mg) of nonopioid analgesia. The measure of the effect was the risk difference (RD) with a 95% confidence interval (CI). The planned interventions were PDE5i vs. placebo, tadalafil vs. placebo, and tadalafil vs. tamsulosin.
Four articles were included in the qualitative and quantitative analysis. Records of 580 patients were found among the four studies. A low risk of bias was shown for the majority of the study items. The calculi expulsion rate had an RD of 0.26 (95% CI, 0.15-0.37) and a less prolonged expulsion as a secondary outcome with a mean difference of -4.39 days (95% CI, -6.69 to -2.09) in favor of PDE5i compared with the placebo. No significant difference was found for these outcomes when comparing tadalafil with tamsulosin.
Compared with a placebo, PDE5i could be effective as MET for the treatment of distal ureter calculi.
确定磷酸二酯酶 5 抑制剂（PDE5i）作为医学排石疗法（MET）治疗远端输尿管结石的疗效。
在 MEDLINE、CENTRAL 和 Embase 数据库中进行了检索策略。还在其他数据库和未发表的文献中进行了搜索。无语言限制纳入临床试验。使用 Cochrane 协作工具评估偏倚风险。由于存在统计学异质性，进行了随机效应分析。主要结局是 28 天内远端输尿管结石的排出率。次要结局是排出时间、治疗副作用和非阿片类镇痛药的用量（mg）。效应的衡量指标是风险差异（RD）及其 95%置信区间（CI）。计划的干预措施是 PDE5i 与安慰剂、他达拉非与安慰剂以及他达拉非与坦索罗辛。
四项研究被纳入定性和定量分析。在四项研究中发现了 580 例患者的记录。大多数研究项目显示出低偏倚风险。与安慰剂相比，PDE5i 的结石排出率 RD 为 0.26（95%CI，0.15-0.37），次要结局的排出时间更短，平均差异为-4.39 天（95%CI，-6.69 至-2.09）。与坦索罗辛相比，他达拉非在这些结局上没有发现显著差异。
与安慰剂相比，PDE5i 可作为 MET 有效治疗远端输尿管结石。
