The efficacy and safety of alpha-Adrenergic blockers for medical expulsion therapy in patients with ureteral calculi A meta-Analysis of placebo-controlled trials

Abstract

Purpose: Alpha-Adrenergic blockers are commonly used as a medical expulsive therapy (MET) for patients with ureteral calculi. The aim of this meta-Analysis was to evaluate the efficacy and safety of alpha-Adrenergic blockers compared with a placebo when used as a MET. Materialsandmethods:We carried out a systematic search of the PubMed, EMBASE, and Web of Science databases, and the Cochrane Library, for relevant articles from inception to November 2020. Our aim was to identify placebo-controlled trails in which patients were randomized to receive either alpha-Adrenergic blockers (tamsulosin, alfuzosin, doxazosin, terazosin, naftopidil, or silodosin) or a placebo for the treatment of ureteral calculi. Results: According to strict inclusion criteria, database searches identified 8 placebo-controlled studies that included 2284 patients. Generally, a-blockers had no significant effect on the clearance of stones in the urinary tract (risk ratio [RR] = 1.05; 95% confidence interval [CI] = 1.00 1.11). However, subgroup analysis showed that a-blockers were effective in treating distal urinary tract stones (RR = 1.08; 95% CI = 1.02 1.15). With regards to adverse events, our analysis showed that the combination of MET with a-blockers was likely to cause dizziness (RR=1.37; 95% CI=1.06 1.79) and retrograde ejaculation (RR=3.10; 95% CI=1.81 5.29). Conclusion: Although a-blockers cannot improve the overall ureteral stone clearance rate, these drugs are still effective for the treatment of stones in the distal urinary tract. However, the application of a-blockers is likely to cause dizziness and/or retrograde ejaculation. Abbreviations: CI = confidence interval, LUTS = lower urinary ract, MET = expulsive therapy, RCT = randomized controlled trial, RR = risk ratio.