Koski Renee R, Zufall William H
Ferris State University, Marquette, MI, USA.
Ferris State University, Ypsilanti, MI, USA.
J Pharm Technol. 2018 Apr;34(2):54-61. doi: 10.1177/8755122517750398. Epub 2017 Dec 25.
To review the literature for α-blocker treatment of kidney stones. PubMed search performed November 15, 2017, using the following search terms: alpha-blocker, alfuzosin, silodosin, or tamsulosin AND kidney or ureteral stones. Additional studies found through references of primary and tertiary literature. Inclusion criteria included English language, randomized controlled trials (not included in meta-analyses), and meta-analyses evaluating US available alpha-blockers as medical expulsive therapy with or without lithotripsy in adults with renal or ureteral stones, and no date limits. Seven randomized controlled trials (RCTs), 1 case-control trial, and 6 meta-analyses were found and included in this review. Two RCTs and 4 meta-analyses evaluated alpha-blockers without lithotripsy. Five RCTs, 1 case-control trial, and 2 meta-analyses evaluated their use post-lithotripsy. The primary endpoint was stone clearance rate in most studies. For ureteral stones ≤10 mm treated without lithotripsy, alpha-blockers increased clearance in all meta-analyses and one RCT versus control. For ureteral or renal stones treated with lithotripsy, 4 RCTs and all meta-analyses found benefit with alpha-blockers compared with control. When results were stratified by stone size, alpha-blockers performed better for stones 10 to 20 mm, while there was no difference for stones <10 mm. Alpha-blockers are beneficial without lithotripsy for ureteral stones 5 to 10 mm. They are beneficial post-lithotripsy for renal or ureteral stones >10 mm. They can be considered post-lithotripsy for stones 5 to 10 mm, but little benefit may be seen. Although all uroselective alpha-blockers have been found to be effective, most data are with tamsulosin 0.4 mg daily.
回顾α受体阻滞剂治疗肾结石的相关文献。于2017年11月15日在PubMed数据库进行检索，检索词如下：α受体阻滞剂、阿夫唑嗪、西洛多辛或坦索罗辛以及肾或输尿管结石。通过一级和三级文献的参考文献找到其他研究。纳入标准包括英文文献、随机对照试验（不包括在荟萃分析中）以及评估美国可用的α受体阻滞剂作为药物排石疗法用于有或无体外冲击波碎石术的成人肾或输尿管结石患者的荟萃分析，且无时间限制。共找到7项随机对照试验（RCT）、1项病例对照试验和6项荟萃分析并纳入本综述。2项RCT和4项荟萃分析评估了未联合体外冲击波碎石术的α受体阻滞剂。5项RCT、1项病例对照试验和2项荟萃分析评估了其在体外冲击波碎石术后的应用。大多数研究的主要终点是结石清除率。对于未行体外冲击波碎石术治疗的直径≤10 mm的输尿管结石，在所有荟萃分析和1项RCT中，α受体阻滞剂与对照组相比可提高结石清除率。对于行体外冲击波碎石术治疗的输尿管或肾结石，4项RCT和所有荟萃分析均发现与对照组相比，α受体阻滞剂有获益。当按结石大小分层分析结果时，α受体阻滞剂对10至20 mm的结石效果更好，而对<10 mm的结石则无差异。α受体阻滞剂对于5至10 mm的输尿管结石在未行体外冲击波碎石术时有益。对于直径>10 mm的肾或输尿管结石，在体外冲击波碎石术后有益。对于5至10 mm的结石，可考虑在体外冲击波碎石术后使用，但获益可能不大。虽然已发现所有尿路选择性α受体阻滞剂均有效，但大多数数据来自每日服用0.4 mg坦索罗辛。
