Tamsulosin as adjunctive treatment after shockwave lithotripsy in patients with upper urinary tract stones: A systematic review and meta-analysis

Objective. This study aimed to evaluate the efficacy of tamsulosin as an α1-blocker in the treatment of the renal and ureteral stones after shockwave lithotripsy (SWL). Material and methods. Relevant randomized controlled trials were identified by electronic and document searches of MEDLINE, EMBASE, the Chinese Biomedical Disk and the Cochrane Central Register of Controlled Trials until April 2010. No language restriction was applied. Trials were included if patients were randomized to receive either tamsulosin or standard therapy with or without placebo after SWL. The main outcome was the stone clearance rate. Two reviewers independently assessed trial quality and extracted data. Meta-analysis was conducted with Review Manager (RevMan) version 5.0. Results. Fifteen studies involving 1326 subjects met the inclusion criteria. Study duration ranged from 2 weeks to 3 months. The pooled analysis showed a 24% [risk ratio (RR) 1.24, 95% confidence interval (CI) 1.12 to 1.37] improvement in stone clearance tamsulosin. According to stone locations (renal, upper ureteral and lower ureteral), the pooling effects of tamsulosin were analysed, with a higher expulsion rate obtained than control (RR 1.38, 1.83, 1.43, and 95% CI 1.17 to 1.61, 1.20 to 2.78, 1.13 to 1.81, respectively). Tamsulosin 0.4 mg had a high possibility of achieving successful outcome (RR 1.29, 95% CI 1.14 to 1.47). In addition, a shorter expulsion time, lower analgesic requirements, fewer colic episodes and adverse effects were observed. Conclusions. Tamsulosin is a safe and effective therapy for renal and ureteral stones after SWL. Further, high-quality randomized trials are necessary to confirm its efficacy. © 2010 Informa Healthcare.