Medical expulsive therapy for ureteric stones: Analysing the evidence from systematic reviews and meta-analysis of powered double-blinded randomised controlled trials

Objective: To conduct a systematic review and meta-analysis investigating the efficacy and safety of medical expulsive therapy (MET) in low risk of bias (RoB) randomised controlled trials (RCTs). Methods: A Cochrane style systematic review was conducted on published literature from 1990 to 2016, to...

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Autores principales:	Tarik Amer, Banan Osman, Allan Johnstone, Martin Mariappan, Ameet Gupta, Nikolaos Brattis, Gareth Jones, Bhaskar K. Somani, Francis X. Keeley, Jr., Omar M. Aboumarzouk
Formato:	article
Lenguaje:	EN
Publicado:	Taylor & Francis Group 2017
Materias:	Ureteric stones Urinary stones α-Blockers Calcium channel blockers Medical expulsive therapy (MET) Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/c5a53fae394244d98d6c0b5f05572b9b
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spelling	oai:doaj.org-article:c5a53fae394244d98d6c0b5f05572b9b2021-12-02T12:02:03ZMedical expulsive therapy for ureteric stones: Analysing the evidence from systematic reviews and meta-analysis of powered double-blinded randomised controlled trials2090-598X10.1016/j.aju.2017.03.005https://doaj.org/article/c5a53fae394244d98d6c0b5f05572b9b2017-06-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2090598X17300414https://doaj.org/toc/2090-598XObjective: To conduct a systematic review and meta-analysis investigating the efficacy and safety of medical expulsive therapy (MET) in low risk of bias (RoB) randomised controlled trials (RCTs). Methods: A Cochrane style systematic review was conducted on published literature from 1990 to 2016, to include low RoB and a power calculation. A pooled meta-analysis was conducted. Results: The MET group included 1387 vs 1381 patients in the control group. The analysis reveals α-blockers increased stone expulsion rates (78% vs 74%) (P < 0.001), whilst calcium channel blockers (CCBs) had no effect compared to controls (79% vs 75%) (P = 0.38). In the subgroup analysis, α-blockers had a shorter time to stone expulsion vs the control group (P < 0.001). There were no significant differences in expulsion rates between the treatment groups and control group for stones <5 mm in size (P = 0.48), proximal or mid-ureteric stones (P = 0.63 and P = 0.22, respectively). However, α-blockers increased stone expulsion in stones >5 mm (P = 0.02), as well as distal ureteric stones (P < 0.001). The α-blocker group developed more side-effects (6.6% of patients; P < 0.001). The numbers needed to treat for α-blockers was one in 14, for stones >5 mm one in eight, and for distal stones one in 10. Conclusion: The primary findings show a small overall benefit for α-blockers as MET for ureteric stones but no benefit with CCBs. α-blockers show a greater benefit for large (>5 mm) ureteric stones and those located in the distal ureter, but no benefit for smaller or more proximal stones. α-blockers are associated with a greater risk of side-effects compared to placebo or CCBs.Tarik AmerBanan OsmanAllan JohnstoneMartin MariappanAmeet GuptaNikolaos BrattisGareth JonesBhaskar K. SomaniFrancis X. Keeley, Jr.Omar M. AboumarzoukTaylor & Francis GrouparticleUreteric stonesUrinary stonesα-BlockersCalcium channel blockersMedical expulsive therapy (MET)Diseases of the genitourinary system. UrologyRC870-923ENArab Journal of Urology, Vol 15, Iss 2, Pp 83-93 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ureteric stones Urinary stones α-Blockers Calcium channel blockers Medical expulsive therapy (MET) Diseases of the genitourinary system. Urology RC870-923
spellingShingle	Ureteric stones Urinary stones α-Blockers Calcium channel blockers Medical expulsive therapy (MET) Diseases of the genitourinary system. Urology RC870-923 Tarik Amer Banan Osman Allan Johnstone Martin Mariappan Ameet Gupta Nikolaos Brattis Gareth Jones Bhaskar K. Somani Francis X. Keeley, Jr. Omar M. Aboumarzouk Medical expulsive therapy for ureteric stones: Analysing the evidence from systematic reviews and meta-analysis of powered double-blinded randomised controlled trials
description	Objective: To conduct a systematic review and meta-analysis investigating the efficacy and safety of medical expulsive therapy (MET) in low risk of bias (RoB) randomised controlled trials (RCTs). Methods: A Cochrane style systematic review was conducted on published literature from 1990 to 2016, to include low RoB and a power calculation. A pooled meta-analysis was conducted. Results: The MET group included 1387 vs 1381 patients in the control group. The analysis reveals α-blockers increased stone expulsion rates (78% vs 74%) (P < 0.001), whilst calcium channel blockers (CCBs) had no effect compared to controls (79% vs 75%) (P = 0.38). In the subgroup analysis, α-blockers had a shorter time to stone expulsion vs the control group (P < 0.001). There were no significant differences in expulsion rates between the treatment groups and control group for stones <5 mm in size (P = 0.48), proximal or mid-ureteric stones (P = 0.63 and P = 0.22, respectively). However, α-blockers increased stone expulsion in stones >5 mm (P = 0.02), as well as distal ureteric stones (P < 0.001). The α-blocker group developed more side-effects (6.6% of patients; P < 0.001). The numbers needed to treat for α-blockers was one in 14, for stones >5 mm one in eight, and for distal stones one in 10. Conclusion: The primary findings show a small overall benefit for α-blockers as MET for ureteric stones but no benefit with CCBs. α-blockers show a greater benefit for large (>5 mm) ureteric stones and those located in the distal ureter, but no benefit for smaller or more proximal stones. α-blockers are associated with a greater risk of side-effects compared to placebo or CCBs.
format	article
author	Tarik Amer Banan Osman Allan Johnstone Martin Mariappan Ameet Gupta Nikolaos Brattis Gareth Jones Bhaskar K. Somani Francis X. Keeley, Jr. Omar M. Aboumarzouk
author_facet	Tarik Amer Banan Osman Allan Johnstone Martin Mariappan Ameet Gupta Nikolaos Brattis Gareth Jones Bhaskar K. Somani Francis X. Keeley, Jr. Omar M. Aboumarzouk
author_sort	Tarik Amer
title	Medical expulsive therapy for ureteric stones: Analysing the evidence from systematic reviews and meta-analysis of powered double-blinded randomised controlled trials
title_short	Medical expulsive therapy for ureteric stones: Analysing the evidence from systematic reviews and meta-analysis of powered double-blinded randomised controlled trials
title_full	Medical expulsive therapy for ureteric stones: Analysing the evidence from systematic reviews and meta-analysis of powered double-blinded randomised controlled trials
title_fullStr	Medical expulsive therapy for ureteric stones: Analysing the evidence from systematic reviews and meta-analysis of powered double-blinded randomised controlled trials
title_full_unstemmed	Medical expulsive therapy for ureteric stones: Analysing the evidence from systematic reviews and meta-analysis of powered double-blinded randomised controlled trials
title_sort	medical expulsive therapy for ureteric stones: analysing the evidence from systematic reviews and meta-analysis of powered double-blinded randomised controlled trials
publisher	Taylor & Francis Group
publishDate	2017
url	https://doaj.org/article/c5a53fae394244d98d6c0b5f05572b9b
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Medical expulsive therapy for ureteric stones: Analysing the evidence from systematic reviews and meta-analysis of powered double-blinded randomised controlled trials

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