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Brain E, Geraghty RM, Tzelves L, Mourmouris P, Chatzikrachtis N, Karavitakis M, Skolarikos A, Somani BK. Outcomes of alpha-blockers as medical expulsive therapy following shockwave lithotripsy: a systematic review and meta-analysis. BJU Int 2023; 131:424-433. [PMID: 36156845 DOI: 10.1111/bju.15901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine stone-free rate following shockwave lithotripsy (SWL) with/without alpha-blockers as well as complication rates (individual and classified using the Clavien-Dindo system). MATERIALS AND METHODS We performed a systematic review of all randomized controlled trials that included more than 20 patients (age > 18 years) and examined the use of alpha-blockers after SWL. Meta-analysis was performed using 'metafor' in R. We report risk ratios (RRs) with 95% confidence intervals (95% CIs). The PROSPERO ID for the trial was: CRD42021248108. RESULTS We assessed 158 full-text articles and included a total of 21 studies in our review. There were 1445 patients receiving alpha-blockers and 1478 control patients. Those receiving alpha-blockers were significantly more likely to be stone-free (RR 1.12, 95% CI 1.07-1.16; P < 0.001). This effect was robust to 'trim-and-fill' adjustment. In those taking alpha-blockers there was a significant reduction in Clavien III-V complications and, on trim-and-fill adjustment, a significant reduction in Clavien I-II complications. There were also significant reduction in rates of steinstrasse, pain and requirement for auxiliary procedures. There was no significant difference in retreatment rates. These effects were robust to trim-and-fill adjustment. CONCLUSIONS There is a modest increase in stone-free rates in those receiving alpha-blockers following SWL, with a reciprocal modest risk reduction for steinstrasse, pain and auxiliary procedures. However, alpha-blockers do not reduce the risk of requiring retreatment.
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Affiliation(s)
- Eleanor Brain
- Newcastle Medical School, Newcastle University, Newcastle-upon-Tyne, UK
| | - Robert M Geraghty
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
- Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Lazaros Tzelves
- Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece
| | - Panagiotis Mourmouris
- Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece
| | - Nikolaos Chatzikrachtis
- Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece
| | - Markos Karavitakis
- Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece
| | - Andreas Skolarikos
- Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
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Maldonado-Valadez RE, Valdez-Vargas AD, Alvarez JA, Rodea-Montero ER. Efficacy of Adjuvant Tamsulosin for Improving the Stone-Free Rate after Extracorporeal Shock Wave Lithotripsy in Renal Stones: A Randomized Controlled Trial. Int J Clin Pract 2022; 2022:3757588. [PMID: 35685573 PMCID: PMC9159172 DOI: 10.1155/2022/3757588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Extracorporeal shock wave lithotripsy (ESWL) is an effective treatment for urolithiasis. Tamsulosin is capable of causing dilation and facilitating the migration of stones. The aim of this study is to evaluate the efficacy of adjuvant treatment with tamsulosin for improving the stone-free rate after a single session of ESWL in the treatment of kidney stones. METHODS This is a randomized, nonplacebo-controlled study with a sample of 60 adults with a single radiopaque kidney stone of 5-20 mm in diameter. After the ESWL session, the patients were divided into two groups. The control group received standard treatment for analgesia consisting of oral diclofenac (75 mg/12 h) as needed. The tamsulosin group received standard treatment for analgesia plus oral tamsulosin (0.4 mg/day) for eight weeks. In both groups, stone-free status was determined using a CT scan eight weeks after ESWL. The protocol of this study was registered with ClinicalTrials.gov, identifier: NCT04819828. RESULTS Only 57 patients completed the study (28 tamsulosin and 29 control). Overall, the average stone diameter was 11.42 ± 4.52 mm. The stone-free rate was 50.88% (29 of 57) overall, 53.57% (15 of 28) for the tamsulosin group, and 48.27% (14 of 29) for the control group (p = 0.680). The estimated relative risk in favor of the tamsulosin group to achieve a stone-free status was 1.11 (95% CI 0.67-1.9). The estimated number needed to treat to achieve a single patient with renal stone-free status after eight weeks of ESWL adjuvant treatment with tamsulosin was 19. CONCLUSION Our findings suggest that tamsulosin as adjuvant treatment after a single ESWL session is well tolerated and safe, but it does not increase the stone-free rate in patients with a single radiopaque renal stone of 5-20 mm in diameter. Our results may support the use of tamsulosin with ESWL in the case of patients with a single radiopaque renal stone of 11-20 mm in diameter based on an apparent higher stone-free rate and a low rate of complications.
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Affiliation(s)
| | | | - José Antonio Alvarez
- Universidad de Guanajuato, Leon, Mexico
- Department of Research, Hospital Regional de Alta Especialidad Del Bajío, Leon, Mexico
| | - Edel Rafael Rodea-Montero
- Universidad de Guanajuato, Leon, Mexico
- Department of Research, Hospital Regional de Alta Especialidad Del Bajío, Leon, Mexico
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3
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Lovegrove CE, Geraghty RM, Yang B, Brain E, Howles S, Turney B, Somani B. Natural history of small asymptomatic kidney and residual stones over a long-term follow-up: systematic review over 25 years. BJU Int 2021; 129:442-456. [PMID: 34157218 DOI: 10.1111/bju.15522] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/16/2021] [Accepted: 06/20/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To systematically review the natural history of small asymptomatic kidney and residual stones, as the incidental identification of small, asymptomatic renal calculi has risen with increasing use of high-resolution imaging. MATERIALS AND METHODS We reviewed the natural history of small asymptomatic kidney and residual stones using the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. We searched MEDLINE, Scopus, EMBASE, EBSCO, Cochrane library and Clinicaltrials.gov using themes of 'asymptomatic', 'nephrolithiasis', 'observation', 'symptoms', 'admission', 'intervention' and similar allied terms for all English language articles from 1996 to 2020 (25 years). Inclusion criteria were studies with ≥50 patients, stones ≤10 mm, and a mean follow-up of ≥24 months. Primary outcomes were occurrence of symptoms, emergency admission, and interventions. RESULTS Our literature search returned 2247 results of which 10 papers were included in the final review. Risk of symptomatic episodes ranged from 0% to 59.4%. Meta-analysis did not identify any significant difference in the likelihood of developing symptoms when comparing stones <5 mm to those >5 mm, nor those <10 mm to those >10 mm. Risk of admission varied from 14% to 19% and the risk of intervention from 12% to 35%. Meta-analysis showed a significantly decreased likelihood of intervention for stones <5 vs >5 mm and <10 vs >10 mm. Studies had variable risk of bias due to heterogeneous reporting of outcome measures with significant likelihood that observed differences in results were compatible with chance alone (Symptoms: I2 =0%, Cochran's Q = 3.09, P = 0.69; Intervention: I2 =0%, Cochran's Q = 1.76, P = 0.88). CONCLUSIONS The present systematic review indicates that stone size is not a reliable predictor of symptoms; however, risk of intervention is greater for stones >5mm vs <5 mm and >10 vs <10 mm. This review will inform urologists as they discuss management strategies with patients who have asymptomatic renal stones and offer insight to committees during the development of evidence-based guidelines.
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Affiliation(s)
- Catherine E Lovegrove
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK.,Department of Surgical Sciences, University of Oxford Nuffield, Oxford, UK
| | - Robert M Geraghty
- Department of Urology, Freeman Hospital, UK.,Translational and Clinical Research Institute, Faculty of Medical Sciences, International Centre for Life, Newcastle University, UK
| | - Bingyuan Yang
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Sarah Howles
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK.,Department of Surgical Sciences, University of Oxford Nuffield, Oxford, UK.,Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Ben Turney
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK.,Department of Surgical Sciences, University of Oxford Nuffield, Oxford, UK
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
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Oestreich MC, Vernooij RW, Sathianathen NJ, Hwang EC, Kuntz GM, Koziarz A, Scales CD, Dahm P. Alpha-blockers after shock wave lithotripsy for renal or ureteral stones in adults. Cochrane Database Syst Rev 2020; 11:CD013393. [PMID: 33179245 PMCID: PMC8092672 DOI: 10.1002/14651858.cd013393.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Shock wave lithotripsy (SWL) is a widely used method to treat renal and ureteral stone. It fragments stones into smaller pieces that are then able to pass spontaneously down the ureter and into the bladder. Alpha-blockers may assist in promoting the passage of stone fragments, but their effectiveness remains uncertain. OBJECTIVES: To assess the effects of alpha-blockers as adjuvant medical expulsive therapy plus usual care compared to placebo and usual care or usual care alone in adults undergoing shock wave lithotripsy for renal or ureteral stones. SEARCH METHODS We performed a comprehensive literature search of the Cochrane Library, the Cochrane Database of Systematic Reviews, MEDLINE, Embase, several clinical trial registries and grey literature for published and unpublished studies irrespective of language. The date of the most recent search was 27 February 2020. SELECTION CRITERIA We included randomized controlled trials of adults undergoing SWL. Participants in the intervention group had to have received an alpha-blocker as adjuvant medical expulsive therapy plus usual care. For the comparator group, we considered studies in which participants received placebo. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion/exclusion, and performed data abstraction and risk of bias assessment. We conducted meta-analysis for the identified dichotomous and continuous outcomes using RevManWeb according to Cochrane methods using a random-effects model. We judged the certainty of evidence on a per outcome basis using GRADE. MAIN RESULTS We included 40 studies with 4793 participants randomized to usual care and an alpha-blocker versus usual care alone. Only four studies were placebo controlled. The mean age of participants was 28.6 to 56.8 years and the mean stone size prior to SWL was 7.1 mm to 13.2 mm. The most widely used alpha-blocker was tamsulosin; others were silodosin, doxazosin, terazosin and alfuzosin. Alpha-blockers may improve clearance of stone fragments after SWL (risk ratio (RR) 1.16, 95% confidence interval (CI) 1.09 to 1.23; I² = 78%; studies = 36; participants = 4084; low certainty evidence). Based on the stone clearance rate of 69.3% observed in the control arm, an alpha-blocker may increase stone clearance to 80.4%. This corresponds to 111 more (62 more to 159 more) participants per 1000 clearing their stone fragments. Alpha-blockers may reduce the need for auxiliary treatments after SWL (RR 0.67, 95% CI 0.45 to 1.00; I² = 16%; studies = 12; participants = 1251; low certainty evidence), but also includes the possibility of no effect. Based on a rate of auxiliary treatments in the usual care arm of 9.7%, alpha-blockers may reduce the rate to 6.5%. This corresponds 32 fewer (53 fewer to 0 fewer) participants per 1000 undergoing auxiliary treatments. Alpha-blockers may reduce major adverse events (RR 0.60, 95% CI 0.46 to 0.80; I² = 0%; studies = 7; participants = 747; low certainty evidence). Major adverse events occurred in 25.8% of participants in the usual care group; alpha-blockers would reduce this to 15.5%. This corresponds to 103 fewer (139 fewer to 52 fewer) major adverse events per 1000 with alpha-blocker treatment. None of the reported major adverse events appeared drug-related; most were emergency room visits or rehospitalizations. Alpha-blockers may reduce stone clearance time in days (mean difference (MD) -3.74, 95% CI -5.25 to -2.23; I² = 86%; studies = 14; participants = 1790; low certainty evidence). We found no evidence for the outcome of quality of life. For those outcomes for which we were able to perform subgroup analyses, we found no evidence of interaction with stone location, stone size or type of alpha-blocker. We were unable to conduct an analysis by lithotripter type. The results were also largely unchanged when the analyses were limited to placebo controlled studies and those in which participants explicitly only received a single SWL session. AUTHORS' CONCLUSIONS Based on low certainty evidence, adjuvant alpha-blocker therapy following SWL in addition to usual care may result in improved stone clearance, less need for auxiliary treatments, fewer major adverse events and a reduced stone clearance time compared to usual care alone. We did not find evidence for quality of life. The low certainty of evidence means that our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect.
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Affiliation(s)
- Makinna C Oestreich
- University of Minnesota Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Robin Wm Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Korea, South
- Institute of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Gretchen M Kuntz
- Borland Health Sciences Library, University of Florida-Jacksonville, Jacksonville, Florida, USA
| | - Alex Koziarz
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Charles D Scales
- Department of Urology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
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5
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Medical Expulsive Therapy for Urinary Stones: Future Trends and Knowledge Gaps. Eur Urol 2019; 76:658-666. [DOI: 10.1016/j.eururo.2019.07.053] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/31/2019] [Indexed: 02/06/2023]
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6
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Sun Y, Lei GL, Yang L, Wei Q, Wei X. Is tamsulosin effective for the passage of symptomatic ureteral stones: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e14796. [PMID: 30855496 PMCID: PMC6417624 DOI: 10.1097/md.0000000000014796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Some trials have stated that there is no benefit to tamsulosin administration for clearing ureteral stones, which is contrary to previous studies. To confirm the efficacy of tamsulosin for treating symptomatic ureteral stones, we performed this review. METHODS We searched the PubMed, Embase, and Cochrane Library databases to identify all studied variables, including tamsulosin, urinary stones, expulsion, and side effects. In addition, for all patients and different stone sizes, the treatment efficacy, expulsion rate, and expulsion time were also recorded for this treatment. RESULTS Forty-nine studies involving 6436 patients met the inclusion criteria. The data synthesized from these studies indicated that tamsulosin improved the renal stone clearance rate (80.5% vs 70.5%; mean difference (MD), 1.16; 95% confidence interval (CI), 1.13-1.19; P <.00001) and reduced the expulsion time (MD, -3.61; 95% CI, -3.77 to -3.46; P ≤.00001). Regarding complications, no significant difference was found between the 2 groups in terms of the total side effects (MD, 1.15; 95% CI, 0.97-1.35; P = .10) or divided complications, including retrograde ejaculation (P = .01), hypotension (P = .52), dizziness (P = .07), diarrhea (P = .58), vomiting (P = .88), headache (P = .84), nausea (P = .91), and fatigue (P = .10). CONCLUSIONS Tamsulosin should be strongly recommended for patients with ureteral stones to increase treatment efficacy. The side effects were not significantly different between the tamsulosin and control treatments.
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Affiliation(s)
- Yi Sun
- Department of Urology, West China Hospital, Sichuan University, Xiang, Chengdu
| | - Guo-Lin Lei
- Department of Urology, Jianyang People Hospital, Jianyang, China
| | - Lu Yang
- Department of Urology, West China Hospital, Sichuan University, Xiang, Chengdu
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, Xiang, Chengdu
| | - Xin Wei
- Department of Urology, West China Hospital, Sichuan University, Xiang, Chengdu
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7
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Sridharan K, Sivaramakrishnan G. Efficacy and safety of alpha blockers in medical expulsive therapy for ureteral stones: a mixed treatment network meta-analysis and trial sequential analysis of randomized controlled clinical trials. Expert Rev Clin Pharmacol 2018; 11:291-307. [DOI: 10.1080/17512433.2018.1424537] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kannan Sridharan
- Associate Professor, Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Gowri Sivaramakrishnan
- Assistant Professor in Prosthodontics, School of Oral Health, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji Islands
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8
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A network meta-analysis on the beneficial effect of medical expulsive therapy after extracorporeal shock wave lithotripsy. Sci Rep 2017; 7:14429. [PMID: 29089544 PMCID: PMC5663967 DOI: 10.1038/s41598-017-14862-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 10/12/2017] [Indexed: 02/05/2023] Open
Abstract
We applied a newly introduced method, network meta-analysis, to re-evaluate the expulsion effect of drugs including tamsulosin, doxazosin, nifedipine, terazosin and rowatinex after extracorporeal shock wave lithotripsy (ESWL) as described in the literature. A systematic search was performed in Medline, Embase and Cochrane Library for articles published before March 2016. Twenty-six studies with 2775 patients were included. The primary outcome was the number of patients with successful stone expulsion. The data were subdivided into three groups according to duration of follow-up. A standard network model was established in each subgroup. In 15-day follow-up results, SUCRA outcome showed the ranking of effects was: doxazosin > tamsulosin > rowatinex > nifedipine > terazosin (88.6, 77.4, 58.6, 32.2 and 30.4, respectively). In 45-day follow-up results, SUCRA ranking was: tamsulosin > nifedipine > rowatinex (69.4, 67.2 and 62.6, respectively). In 90-day follow-up results, SUCRA ranking was: doxazosin > rowatinex > tamsulosin (84.1, 68.1 and 49.1, respectively). In conclusion, doxazosin and tamsulosin have potential to be the first choice for pharmacological therapy to promote the expulsion of urinary stone fragments after ESWL, with this doxazosin can improve the SFR in the long term, while tamsulosin may result more in accelerating the process of expulsion.
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9
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Sridharan K, Sivaramakrishnan G. Medical expulsive therapy in urolithiasis: a mixed treatment comparison network meta-analysis of randomized controlled clinical trials. Expert Opin Pharmacother 2017; 18:1421-1431. [DOI: 10.1080/14656566.2017.1362393] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Kannan Sridharan
- School of Health Sciences, Fiji National University, Suva, Fiji Islands
| | - Gowri Sivaramakrishnan
- School of Oral Health, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji Islands
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10
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Medical Expulsive Therapy in Urolithiasis: A Review of the Quality of the Current Evidence. Eur Urol Focus 2017; 3:27-45. [DOI: 10.1016/j.euf.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/10/2017] [Accepted: 05/02/2017] [Indexed: 01/30/2023]
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11
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Tamsulosin for urolithiasis: a review of the recent literature and current controversies. Am J Emerg Med 2016; 34:2217-2221. [DOI: 10.1016/j.ajem.2016.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 09/06/2016] [Accepted: 09/06/2016] [Indexed: 01/18/2023] Open
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12
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Wang H, Man LB, Huang GL, Li GZ, Wang JW. Comparative efficacy of tamsulosin versus nifedipine for distal ureteral calculi: a meta-analysis. Drug Des Devel Ther 2016; 10:1257-65. [PMID: 27099471 PMCID: PMC4820282 DOI: 10.2147/dddt.s99330] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The aim of this study was to systematically compare the therapeutic effect and safety of tamsulosin with nifedipine in medical expulsive therapy for distal ureteral calculi. METHODS Databases, including PubMed, EMBASE, the Cochrane Library, and Clinical Trial Register Centers, were comprehensively searched. Relevant randomized controlled trials (RCTs) were selected, and quality assessment was performed according to the Cochrane Handbook. RevMan software was used to analyze the outcome measures, which consisted of expulsion rate, expulsion time, and complications. RESULTS Twelve RCTs consisting of 4,961 patients were included (tamsulosin group, 2,489 cases; nifedipine group, 2,472 cases). Compared with nifedipine, tamsulosin significantly increased the expulsion rate (risk ratio =1.29, 95% CI [1.25, 1.33], P<0.0001) and reduced the expulsion time (standard mean difference =-0.39, 95% CI [-0.72, -0.05], P=0.02). Regarding safety, tamsulosin was associated with fewer complications than nifedipine (risk ratio =0.45, 95% CI [0.28, 0.72], P=0.0008), and further subgroup analysis showed that tamsulosin was associated with a lower risk of both mild and moderate-to-severe complications. CONCLUSION On the bias of current evidence, tamsulosin showed an overall superiority to nifedipine for distal ureteral calculi <10 mm in aspects of expulsion rate, expulsion time, and safety. Tamsulosin was supposed to be the first drug to be recommended to patients willing to receive medical expulsive therapy.
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Affiliation(s)
- Hai Wang
- Department of Urology, Beijing Jishuitan Hospital, Beijing, People’s Republic of China
| | - Li Bo Man
- Department of Urology, Beijing Jishuitan Hospital, Beijing, People’s Republic of China
| | - Guang Lin Huang
- Department of Urology, Beijing Jishuitan Hospital, Beijing, People’s Republic of China
| | - Gui Zhong Li
- Department of Urology, Beijing Jishuitan Hospital, Beijing, People’s Republic of China
| | - Jian Wei Wang
- Department of Urology, Beijing Jishuitan Hospital, Beijing, People’s Republic of China
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13
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Zargar-Shoshtari K, Sharma P, Zargar H. Re: Medical Expulsive Therapy in Adults with Ureteric Colic: A Multicentre, Randomised, Placebo-controlled Trial. Eur Urol 2015; 68:910-1. [PMID: 26460878 DOI: 10.1016/j.eururo.2015.07.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Pranav Sharma
- Department of Urology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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14
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Skolarikos A, Grivas N, Kallidonis P, Mourmouris P, Rountos T, Fiamegos A, Stavrou S, Venetis C. The Efficacy of Medical Expulsive Therapy (MET) in Improving Stone-free Rate and Stone Expulsion Time, After Extracorporeal Shock Wave Lithotripsy (SWL) for Upper Urinary Stones: A Systematic Review and Meta-analysis. Urology 2015; 86:1057-64. [PMID: 26383613 DOI: 10.1016/j.urology.2015.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 08/31/2015] [Accepted: 09/01/2015] [Indexed: 10/23/2022]
Abstract
In this meta-analysis, we included randomized studies on medical expulsive therapy implemented following shock wave lithotripsy for renal and ureteral stones. Pooled results demonstrated the efficacy of α-blockers, nifedipine, Rowatinex, and Uriston in increasing stone clearance. In addition, the time to stone elimination, the intensity of pain, the formation of steinstrasse, and the need for auxiliary procedures were reduced mainly with α-blockers. Expulsion rate was not correlated with the type of α-blocker, the diameter, and the location of stone. Our results show that medical expulsive therapy for residual fragments after shock wave lithotripsy should be implemented in clinical practice.
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Affiliation(s)
- Andreas Skolarikos
- Second Department of Urology, Athens Medical School, Sismanogleio General Hospital, Athens, Greece
| | - Nikolaos Grivas
- Department of Urology, G. Hatzikosta General Hospital, Ioannina, Greece.
| | | | - Panagiotis Mourmouris
- Second Department of Urology, Athens Medical School, Sismanogleio General Hospital, Athens, Greece
| | - Thomas Rountos
- Department of Urology, Ippokrateio General Hospital, Thessaloniki, Greece
| | - Alexandros Fiamegos
- Second Department of Urology, Athens Medical School, Sismanogleio General Hospital, Athens, Greece
| | | | - Chris Venetis
- First Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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15
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Chen K, Mi H, Xu G, Liu L, Sun X, Wang S, Meng Q, Lv T. The Efficacy and Safety of Tamsulosin Combined with Extracorporeal Shockwave Lithotripsy for Urolithiasis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Endourol 2015; 29:1166-76. [PMID: 25915454 DOI: 10.1089/end.2015.0098] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Many studies have been conducted to investigate adjunctive tamsulosin therapy after extracorporeal shockwave lithotripsy (SWL) for urolithiasis. The results from those studies, however, are still inconsistent. Therefore, we performed a meta-analysis to provide an update on the clinical efficacy and safety of tamsulosin combined with SWL for urolithiasis. METHODS A systematic search was performed in PubMed, Cochrane Library, and Embase to identify all relevant randomized controlled trials until January 2015. Two reviewers independently assessed trial quality and extracted data. Meta-analysis was conducted with Review Manager (RevMan), version 5.1. RESULTS Twenty-one studies (2093 subjects in total) were identified in the current meta-analysis. Compared with a control group, the experimental group (tamsulosin combined with SWL) showed an increased overall benefit for stone expulsion, with pooled risk ratio (RR) of 1.20 (95% confidence interval [CI], 1.15-1.26). With respect to the different geographic regions, European and American had a high possibility of improvement in stone expulsion (RR: 1.33, 95% CI, 1.19-1.49). According to the stone locations (renal, upper and lower ureteral) and sizes (4-10 mm and 11-24 mm), tamsulosin is more useful for lower ureteral stone (RR: 1.28; 95% CI, 1.14-1.43) and larger sized stones (RR: 1.49; 95% CI, 1.28-1.75). The effect estimates did not vary markedly when stratified by follow-up durations but varied by dose of tamsulosin. Furthermore, a shorter expulsion time, reduced occurrence of steinstrasse, fewer incidences of colic, and lower analgesic requirements were observed within the experimental group. In addition, tamsulosin is well tolerated, and its adverse events rarely led to dropouts of patients. CONCLUSIONS Overall, evidence suggests that tamsulosin combined with SWL is safe and effective in enhancing stone expulsion for patients with urolithiasis. Furthermore, high-quality, randomized and placebo-controlled trials evaluating the efficacy and safety of tamsulosin should be performed.
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Affiliation(s)
- Kai Chen
- 1 Department of Urology, The People's Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College , Shandong Province, China
| | - Hua Mi
- 2 Institute of Urology and Nephrology, First Affiliated Hospital of Guangxi Medical University , Nanning, Guangxi Zhuang Autonomous Region, China
| | - Guangyu Xu
- 1 Department of Urology, The People's Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College , Shandong Province, China
| | - Lin Liu
- 3 Department of Oncology, The People's Hospital of AnQiu City , Shandong Province, China
| | - Xiubin Sun
- 1 Department of Urology, The People's Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College , Shandong Province, China
| | - Shiping Wang
- 1 Department of Urology, The People's Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College , Shandong Province, China
| | - Qingrong Meng
- 1 Department of Urology, The People's Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College , Shandong Province, China
| | - Tao Lv
- 1 Department of Urology, The People's Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College , Shandong Province, China
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Vicentini FC. Difference of opinion--In the era of flexible ureteroscopy is there still a place for Shock-wave lithotripsy? Opinion: NO. Int Braz J Urol 2015; 41:203-6. [PMID: 26005960 PMCID: PMC4752081 DOI: 10.1590/s1677-5538.ibju.2015.02.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Fabio C Vicentini
- Endourology and Lithiasis Section, Division of Urology, Hospital das Clinicas, University of São Paulo, School of Medicine, São Paulo, Brazil.,Section of Endourology, Department of Urology, Hospital Brigadeiro, São Paulo, Brazil
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Liu CC, Hsieh HM, Wu CF, Hsieh TJ, Huang SP, Chou YH, Huang CN, Wu WJ, Wu MT. Long-term prescription of α-blockers decrease the risk of recurrent urolithiasis needed for surgical intervention-a nationwide population-based study. PLoS One 2015; 10:e0122494. [PMID: 25875226 PMCID: PMC4395263 DOI: 10.1371/journal.pone.0122494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 02/22/2015] [Indexed: 11/23/2022] Open
Abstract
Purpose α1 receptors and subtypes have been confirmed to distribute in human pelvis and calyces recently. As used in ureteral stones, α-blocker treatment may facilitate kidney stone passage and long-term prescription of α-blocker may decrease the risk of recurrent urolithiasis. The aim of this study is to determine if use of α-blockers 180 days or more can decrease the risk of recurrent urolithiasis needed for surgical intervention. Materials and Methods A representative database of 1,000,000 patients from Taiwan’s National Health Insurance was analyzed. Eligible patients were those who had received the first-time procedure for upper urinary stone removal, including extracorporeal shock-wave lithotripsy, ureterorenoscopic lithotripsy, or both, between 2000 and 2010. After completing a 180-day treatment for first event, patients were prospectively followed-up until a second set of stone procedures was performed (proxy of stone recurrence), loss to follow-up, or end of study. The effect of percentage of total number of days of α-blocker use on need for second set of stone procedures within a post treatment 180-day follow-up period was analyzed by quartile. A nested case-control study was also performed. Results 1,259 patients were eligible for final analyses. During 3,980 person-years follow-up, 167 patients had recurrent urolithiasis needed for surgical intervention. From first to fourth quartile of drug exposure, recurrence rates were 45.64, 47.19, 43.11, and 18.52 per 1,000 person-years. The adjusted hazard ratio was 0.46 (95% CI = 0.24 to 0.89) for the fourth quartile (vs. quartile 1). In the nested case-control study, adjusted ORs was 0.23 (95% CI = 0.10 to 0.53) in the fourth quartile (vs. quartile 1). The results remained similar even in patients categorized by cumulative defined daily dose (cDDD) quartiles and average cDDD per day quartiles. Conclusion Use of α-blockers for 180 days or more decrease the risk of recurrent urolithiasis needed for surgical intervention. In patients at higher risk of recurrent urolithiasis, long term prescription of α-blockers might help them prevent further surgical intervention.
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Affiliation(s)
- Chia-Chu Liu
- Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Urology, Pingtung Hospital, Ministry of Health and Welfare, Executive Yuan, Pingtung, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chia-Fang Wu
- Department of Public Health, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Tusty-Jiuan Hsieh
- Department of Medical Genetics, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Shu-Pin Huang
- Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Yii-Her Chou
- Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chun-Nung Huang
- Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Wen-Jeng Wu
- Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Ming-Tsang Wu
- Department of Public Health, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Center of Environmental and Occupational Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- * E-mail:
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Li M, Wang Z, Yang J, Guo X, Wang T, Wang S, Yin C, Liu J, Ye Z. Adjunctive medical therapy with α-blocker after extracorporeal shock wave lithotripsy of renal and ureteral stones: a meta-analysis. PLoS One 2015; 10:e0122497. [PMID: 25860144 PMCID: PMC4393103 DOI: 10.1371/journal.pone.0122497] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 02/22/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Although some trials assessed the efficacy and safety of the α-blocker in facilitating renal and ureteral stones expulsion after extracorporeal shock wave lithotripsy (ESWL), the role of the α-blocker in facilitating upper urinary calculi expulsion after ESWL remain controversial. AIMS To determine the efficacy and safety of the α-blocker in facilitating renal and ureteral stones expulsion after ESWL. METHODS A literature search was carried out using the PubMed database, EMBASE and the Cochrane Library database to identify relevant studies. Two reviewers independently extracted data and assessed methodological quality. Pooled effect estimates were obtained using a fixed- and random-effects meta-analysis. RESULTS The meta-analysis included 23 RCTs, α-blocker significantly enhanced expulsion rate of upper urinary tract calculi after ESWL (P<0.00001; RR 1.21; 95% CI 1.12-1.31), significantly promoted steinstrasse expulsion (P=0.03; RR 1.25; 95% CI 1.03-1.53), significantly shortened the discharge time of upper urinary tract calculi (P=0.0001; MD -2.12; 95% CI -3.20--1.04), significantly reduced the patient's pain VAS score (P=0.001; RR -1.0; 95% CI -1.61--0.39). Compared with the control group, dizziness (P=0.002; RR 5.48; 95% CI 1.91-15.77), anejaculation (P=0.02; RR 12.17; 95% CI 1.61-91.99) and headache (P=0.04; RR 4.03; 95% CI 1.04-15.72) in the α-blocker group was associated with a higher incidence. CONCLUSIONS Treatment with α-blocker after ESWL appears to be effective in enhancing expulsion rate of upper urinary tract calculi, shortening the discharge time of upper urinary tract calculi, reducing the patient's pain. The side effects of α-blocker were light and few.
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Affiliation(s)
- Mingchao Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, P. R. China
| | - Zhengyun Wang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Jun Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, P. R. China
| | - Xiaolin Guo
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, P. R. China
- * E-mail: (XLG); (CPY)
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, P. R. China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, P. R. China
| | - Chunping Yin
- Department of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail: (XLG); (CPY)
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, P. R. China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, P. R. China
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Torricelli FCM, Danilovic A, Vicentini FC, Marchini GS, Srougi M, Mazzucchi E. Extracorporeal shock wave lithotripsy in the treatment of renal and ureteral stones. Rev Assoc Med Bras (1992) 2015; 61:65-71. [PMID: 25909212 DOI: 10.1590/1806-9282.61.01.065] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/02/2014] [Indexed: 11/21/2022] Open
Abstract
The use of certain technical principles and the selection of favorable cases can optimize the results of extracorporeal shock wave lithotripsy (ESWL). The aim of this study is to review how ESWL works, its indications and contraindications, predictive factors for success, and its complications. A search was conducted on the Pubmed® database between January 1984 and October 2013 using "shock wave lithotripsy" and "stone" as key-words. Only articles with a high level of evidence, in English, and conducted in humans, such as clinical trials or review/meta-analysis, were included. To optimize the search for the ESWL results, several technical factors including type of lithotripsy device, energy and frequency of pulses, coupling of the patient to the lithotriptor, location of the calculus, and type of anesthesia should be taken into consideration. Other factors related to the patient, stone size and density, skin to stone distance, anatomy of the excretory path, and kidney anomalies are also important. Antibiotic prophylaxis is not necessary, and routine double J stent placement before the procedure is not routinely recommended. Alpha-blockers, particularly tamsulosin, are useful for stones >10mm. Minor complications may occur following ESWL, which generally respond well to clinical interventions. The relationship between ESWL and hypertension/diabetes is not well established.
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Affiliation(s)
| | - Alexandre Danilovic
- Hospital das Clínicas, Medical School's, University of São Paulo, São Paulo, SP, Brazil
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A comparison of nifedipine and tamsulosin as medical expulsive therapy for the management of lower ureteral stones without ESWL. Sci Rep 2014; 4:5254. [PMID: 24919112 PMCID: PMC4052729 DOI: 10.1038/srep05254] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/22/2014] [Indexed: 02/05/2023] Open
Abstract
Administration of nifedipine or tamsulosin has been suggested to augment stone expulsion rates. We aimed to compare the stone expulsion rates and adverse effects associated with the use of nifedipine or tamsulosin as medical expulsive therapy (MET) for the management of lower ureteral stones (LUS) without extracorporeal shock wave lithotripsy (ESWL) via a literature review and meta-analysis. Relevant randomized controlled trials (RCTs) were identified from the Medline, EMBASE, Cochrane CENTRAL, and Google Scholar databases. Finally, a total of 7 RCTs with 3897 patients were included. Our meta-analysis showed that tamsulosin could significantly increase the stone expulsion rate relative to nifedipine in patients with LUS (random-effects model; risk ratio [RR] = 0.81; 95% confidence interval [CI] = 0.75–0.88; P < 0.00001). The subgroup analysis indicated no statistically significant difference between the drugs with regard to minor or major adverse effects (fixed-effect model; RR = 1.19, 95% CI = 0.91–1.54, P = 0.20; and RR = 1.63, 95% CI = 0.22–11.82, P = 0.63, respectively). This meta-analysis demonstrated that tamsulosin was more effective than nifedipine in patients with LUS, as evidenced by the higher stone expulsion rate. Tamsulosin treatment should therefore be considered for patients with LUS.
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Gul U, Yaycıoglu O, Kuzgunbay B, Sarıturk C, Kayra MV, Ozkardes H. Do patients on alpha-blockers for the treatment of benign prostatic hyperplasia have better results after shockwave lithotripsy of urinary stones? J Endourol 2013; 27:612-6. [PMID: 23237326 DOI: 10.1089/end.2012.0630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To investigate whether patients who are on alpha 1-adrenergic receptor (alpha 1-AR) antagonists for the treatment of benign prostatic hyperplasia (BPH) had better results after extracorporeal shockwave lithotripsy (SWL). PATIENTS AND METHOD We retrospectively reviewed the records of male patients older than 50 years who underwent SWL. Clinical characteristics, including the use of alpha 1-AR antagonists for BPH were analyzed. Mann-Whitney U test was used for data not normally distributed and student's t test for data normally distributed. The categorical variables were analyzed by the Chi-square test. A multiple logistic regression analysis was used to analyze the associations of variables on successful treatment. RESULTS A total of 264 renal units were treated. Complete stone clearance was achieved in 167 RUs (63.3%) and 28 RUs (10.6%) had clinically insignificant residual fragments. In 69 RUs (26.1%), SWL failed. More patients were on alpha 1-AR antagonists for BPH in the successfully treated group (p=0.028). The multivariate analysis revealed that the use of alpha 1-AR antagonists had significant effects on the success of SWL (p=0.047). SWL was performed to 34 RUs of 33 patients who were on alpha 1-AR antagonists and it was successful in 30 RUs (88.2%). In the remaining 230 RUs, stone-free state was achieved in 165 RUs (71.7%) (p=0.028). Stone-free rates were similar for patients on alfuzosine, tamsulosine, and doxazosine (p=0.310). CONCLUSION Patients who are being treated with alpha 1-AR antagonist agents for BPH have better results after SWL treatment, compared to patients not receiving alpha 1-AR antagonist. The improved results are independent of the type of alpha 1-AR antagonist.
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Affiliation(s)
- Umit Gul
- Department of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey .
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Aspects on how extracorporeal shockwave lithotripsy should be carried out in order to be maximally effective. ACTA ACUST UNITED AC 2012; 40:433-46. [DOI: 10.1007/s00240-012-0485-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 05/22/2012] [Indexed: 01/20/2023]
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