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Sun F, Liu H, Wu G, Liu M, Liu S, Wang L, Zou Q, Cui Y, Wu J. Pooled-analysis of tadalafil and tamsulosin for ureteral calculi. Front Pharmacol 2024; 15:1351312. [PMID: 38873423 PMCID: PMC11169629 DOI: 10.3389/fphar.2024.1351312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Objective Urolithiasis is a common urological diseases and affects the daily life of patients. Medical expulsive therapy has become acceptable for many parents. We conducted a meta-analysis to determine the efficacy and safety of tadalafil compared with tamsulosin for treating distal ureteral stones less than 10 mm in length. Methods Related studies were identified via searches of the PubMed, Embase, and Cochrane Library databases. All the articles that described the use of tadalafil and tamsulosin for treating distal ureteral stones were collected. Results A total of 14 studies were included in our meta-analysis. Our results revealed that tadalafil enhanced expulsion rate [odds ratio (OR) = 0.68, 95% confidence interval (CI): 0.47 to 0.98, p = 0.04]; reduced expulsion time [mean difference (MD) = 1.22, 95% CI (0.13, 2.30), p = 0.03]; lowered analgesia use [MD = 38.66, 95% CI (7.56, 69.77), p = 0.01] and hospital visits [MD = 0.14, 95% CI (0.06, 0.22), p = 0.0006]. According to our subgroup analysis, either tadalafil 5 mg or 10 mg did not promote expulsion rate and accelerate expulsion time compared with tamsulosin. But patients receiving 5 mg tadalafil decreased analgesia usage [MD = 101.04, 95% CI (67.56, 134.01), p < 0.00001]. Conclusion Compared with tamsulosin, tadalafil demonstrates a higher expulsion rate and less expulsion time for patients with distal ureteral stones less than 10 mm with a favorable safety profile.
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Affiliation(s)
- Fengze Sun
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Hongquan Liu
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Gang Wu
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Ming Liu
- The Second Clinical Medical College, Binzhou Medical University, Yantai, Shandong, China
| | - Shangjing Liu
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Lin Wang
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Qingsong Zou
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Yuanshan Cui
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Jitao Wu
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
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Belkovsky M, Zogaib GV, Passerotti CC, de Almeida Artifon EL, Otoch JP, da Cruz JAS. Tamsulosin vs. Tadalafil as medical expulsive therapy for distal ureteral stones: a systematic review and meta-analysis. Int Braz J Urol 2023; 49:668-676. [PMID: 37903004 PMCID: PMC10947629 DOI: 10.1590/s1677-5538.ibju.2023.0345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/26/2023] [Indexed: 11/01/2023] Open
Abstract
PURPOSE Medical expulsive therapy (MET) is recommended for distal ureteral stones from 5 to 10 mm. The best drug for MET is still uncertain. In this review, we aim to compare the effectiveness of tadalafil and tamsulosin for distal ureteral stones from 5 to 10 mm in terms of stone expulsion rate (SER), stone expulsion time (SET) and the side effect profile. MATERIALS AND METHODS A comprehensive literature search was conducted on MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scopus and Web of Science, from inception until April 2023. Only randomized controlled trials were included in the analysis. RESULTS Eleven publications with 1,330 patients were included. We observed that tadalafil has a higher SER (OR 0.55, CI 95% 0.38;0.80, p=0.02, I2=52%) and the same efficacy in SET (MD 1.07, CI 95% -0.25; 2.39, p=0.11, I2=84%). No differences were found when comparing side effects as headache, backache, dizziness, and orthostatic hypotension. CONCLUSION Tadalafil has a higher stone expulsion rate than tamsulosin as a medical expulsive therapy for patients with distal stones from 5 to 10 mm without differences in side effects.
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Affiliation(s)
- Mikhael Belkovsky
- Universidade de São PauloDepartamento de Técnica CirúrgicaSão PauloSPBrasilDepartamento de Técnica Cirúrgica, Universidade de São Paulo - USP, São Paulo, SP, Brasil;
| | - Giulia Veneziani Zogaib
- Universidade Nove de JulhoDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Universidade Nove de Julho, São Paulo, SP, Brasil
| | - Carlo Camargo Passerotti
- Serviço de Urologia Hospital Alemão Oswaldo CruzSão PauloSPBrasilServiço de Urologia Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
| | - Everson Luiz de Almeida Artifon
- Universidade de São PauloDepartamento de Técnica CirúrgicaSão PauloSPBrasilDepartamento de Técnica Cirúrgica, Universidade de São Paulo - USP, São Paulo, SP, Brasil;
| | - José Pinhata Otoch
- Universidade de São PauloDepartamento de Técnica CirúrgicaSão PauloSPBrasilDepartamento de Técnica Cirúrgica, Universidade de São Paulo - USP, São Paulo, SP, Brasil;
| | - José Arnaldo Shiomi da Cruz
- Universidade de São PauloDepartamento de Técnica CirúrgicaSão PauloSPBrasilDepartamento de Técnica Cirúrgica, Universidade de São Paulo - USP, São Paulo, SP, Brasil;
- Universidade Nove de JulhoDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Universidade Nove de Julho, São Paulo, SP, Brasil
- Serviço de Urologia Hospital Alemão Oswaldo CruzSão PauloSPBrasilServiço de Urologia Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
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Abdelaal MA, El-Dydamony EM. Comparative study between Tamsulosin, Silodosin and Tadalafil as a medical expulsive therapy for lower ureteral stones. Arch Ital Urol Androl 2023; 95:10849. [PMID: 36924384 DOI: 10.4081/aiua.2023.10849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/06/2022] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE To compare the efficacy of Tamsulosin, Silodosin and Tadalafil as a medical expulsive therapy for treatment of distal ureteral calculi. PATIENTS AND METHODS Over a period of 6 months (January 2022 to June 2022) this prospective randomized study was conducted on 170 patients with distal ureteric stone ≤ 10 mm. Patients were randomly divided into three groups. Patients in group A received Tamsulosin 0.4mg, in group B received Silodosin, and in group C receive Tadalafil 5 mg. Therapy was given for a maximum of 4 weeks. The rate and time of stone expulsion, the analgesic use, attacks of colic and hospital visits for pain, and adverse effects of drugs were recorded. RESULTS Among 170 patients who were enrolled in study, 20 were lost to follow-up (7, 8, 5 in group A, B, And C respective-ly). There was a significant higher stone passage rate in group C than group A and B (90% vs. 70% and 76% respectively; p-value = 0.043) and shorter expulsion time in group C (8.7 ± 3.3 days) vs. group A (12.5 ± 5.2 days) and group B (11.3 ± 4.2 days) with (p-value = 0.001)(highly statistically significant with p-value < 0.001) and increased amount of analgesics required in group A (225 ± 115.7 mg) and group B (163 ± 77.5 mg) when compared with group C (120 ± 55.3 mg). CONCLUSION Tadalafil is more effective than Tamsulosin and Silodosin in treatment of patients with distal ureteric stones ≤ 10 mm as regard stone expulsion rate, expulsion time with decreased number of colicky episodes and side effects.
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K S, L A, Sathish V, Achar M U, Raj K C B, Pai N. An update on efficacy and safety of alpha-blockers in the treatment of distal ureteric stones: narrative review. AFRICAN JOURNAL OF UROLOGY 2022. [DOI: 10.1186/s12301-022-00310-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Alpha-blockers prescribed as medical expulsion therapy (MET) have replaced minimally invasive procedures as the primary line of treatment for minor ureteric stones. This study aims to investigate the efficacy of MET with alpha-blockers in terms of stone expulsion rate and time and evaluate the safety of several alpha-blockers.
Methodology
Google Scholar, PubMed, and Web of Science databases were searched for relevant publications using keywords published between December 2013 and August 2021. Additional relevant research was found by looking through the references in the articles.
Results
To determine the efficacy and safety of alpha-blockers as a medical expulsive therapy for the management of distal ureteral stones, 15 studies were included, 12 randomized control trials, 2 retrospective observational studies, and 1 prospective study. The most commonly studied primary endpoint was stone expulsion rate and time. According to findings, silodosin appears to be more effective than other alpha-blockers. The data revealed no life-threatening adverse effects were associated with alpha-blockers.
Conclusion
Alpha-blockers are recommended as the first-line therapy for distal ureteral stones. Silodosin was the most efficacious medicine, according to the data. The side effects of alpha-blockers, on the other hand, were minor, consisting primarily of orthostatic hypotension. The alpha-blocker choice differs from urologist to urologist in the management of MET, depending on their experience and the patient's condition.
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Abdel-Basir Sayed M, Mohamed Moeen A, Saada H, Nassir A, Tayib A, Ahmed Gadelkareem R. Mirabegron as a Medical Expulsive Therapy for 5-10 mm Distal Ureteral Stones: A Prospective, Randomized, Comparative Study. Turk J Urol 2022; 48:209-214. [PMID: 35634939 PMCID: PMC9730259 DOI: 10.5152/tud.2022.22014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this study was to assess the efficacy and safety of mirabegron as a medical expulsive therapy in patients with distal ureteral stones of 5-10 mm size. MATERIAL AND METHODS A prospective, comparative study included 96 patients with radiopaque distal ure- teral stones of 5-10 mm who were randomly allocated and treated by medical expulsive therapy in 2 groups from January 2019 to December 2020. Patients in group A received only ketorolac 30 mg/day for 5 days, then on demand. Patients in group B received mirabegron 50 mg/day for 4 weeks plus ketorolac 30 mg/day like in group A. The stone expulsion rate was the primary outcome. RESULTS There were no significant differences regarding age, gender, body mass index, laterality, degree of hydronephrosis, and stone size. After 4 weeks, stone expulsion rate was 52.1% for group A versus 89.6% for group B (P < .001). The median (range) of time to stone expulsion was 14 (13-23) and 7 (3-16) days for groups A and B, respectively (P = .004). The medians (range; interquartile range) of episodes of renal pain (1 (0-2; 1) vs. (0-2; 2); P < .001) and extra analgesic ampoules (1 (0-7; 4) vs. 0 (0-2; 0) vials; P < .001) were significantly higher in group A than those in group B, respectively. In multivariate analysis, only medical expulsive therapy (P <.001) and stone size (P < .001) were independent predictors of stone expulsion rate. CONCLUSION Mirabegron is an effective and safe medical expulsive therapy agent in patients with 5-10 mm distal ureteral stones.
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Affiliation(s)
| | | | - Hesham Saada
- Department of Surgery, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Anmar Nassir
- Department of Surgery, Umm Al Qura University, Makkah, Saudi Arabia
| | - Abdulmalik Tayib
- King Abdulaziz University Hospital and International Medical Center, Jeddah, Saudi Arabia
| | - Rabea Ahmed Gadelkareem
- Endourology Unit, Assiut Urology Hospital, Assiut University, Assiut, Egypt
- Corresponding author:Rabea Ahmed GadelkareemE-mail:
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Cai D, Wei G, Wu P, Huang Y, Che X, Zhang Y, Zhou Z, Kong G. The Efficacy of Mirabegron in Medical Expulsive Therapy for Ureteral Stones: A Systematic Review and Meta-Analysis. Int J Clin Pract 2022; 2022:2293182. [PMID: 35685505 PMCID: PMC9159211 DOI: 10.1155/2022/2293182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/15/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This study aimed to assess the efficacy of mirabegron (50 mg daily) as a medical expulsive therapy for ureteral stones in adults. MATERIALS AND METHODS We searched PubMed, Embase, Cochrane Library, and Web of Science from inception to July 2021 to collect the clinical trials. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies by using the Cochrane risk of bias tool. Review Manager 5.3 software was used for the meta-analysis. RESULTS A total of four studies were included, involving 398 patients: 197 patients in mirabegron group and 201 patients in control group. The meta-analysis showed that the stone expulsion rate was higher in the mirabegron group than in the control group (OR: 2.12; 95% CI: 1.33 to 3.40; p=0.002). Subgroup analysis identified that the stone expulsion rate of patients with stone size <5/6 mm was significantly higher than that of patients with stone size ≥5/6 mm (OR: 0.31; 95% CI: 0.13 to 0.72; p=0.006). But no significant difference was identified between the mirabegron group and the control group for the stone expulsion interval (MD: -1.16, 95% CI: -3.56 to 1.24; p=0.35). In terms of pain episodes, the mirabegron group was significantly lower than that of the control group (MD: -0.34, 95% CI: -0.50 to 0.19; p < 0.0001). CONCLUSIONS The medical expulsive therapy with mirabegron had a significant effect in improving the stone expulsion rate for patients with ureteral stones, especially in those whose stone size <5/6 mm. Mirabegron had no effect on the stone expulsion interval but did decrease the pain episodes.
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Affiliation(s)
- Dawei Cai
- Department of Urology, Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, Tongzhou District, Beijing 101149, China
| | - Guangzhu Wei
- Department of Urology, Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, Tongzhou District, Beijing 101149, China
| | - Peishan Wu
- Department of Urology, Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, Tongzhou District, Beijing 101149, China
| | - Yongjin Huang
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China
| | - Xuanyan Che
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China
| | - Yong Zhang
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China
| | - Zhongbao Zhou
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China
| | - Guangqi Kong
- Department of Urology, Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, Tongzhou District, Beijing 101149, China
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Sharma G, Kaundal P, Pareek T, Tyagi S, Sharma AP, Devana SK, Singh SK. Comparison of efficacy of various drugs used for medical expulsive therapy for distal ureter stones: A systematic review and network meta-analysis. Int J Clin Pract 2021; 75:e14214. [PMID: 33825273 DOI: 10.1111/ijcp.14214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Medical expulsive therapy has been found to be effective for distal ureteric stones; however, which drug is most efficacious in terms of stone expulsion rate (SER) and stone expulsion time (SET) is not known. With this review we aimed to compare the efficacy of various drug treatments for distal ureter stones used as medical expulsive therapy in terms of SER and SET. METHODS Systematic literature search was conducted to include all the randomised study comparing various drug interventions for lower ureter stones. Standard preferred reporting items for systematic review and meta-analysis for network meta-analysis (PRISMA-NMA) were pursued. RESULTS In this review, 50 randomised studies with 12,382 patients were included. For stone expulsion rate (SER), compared with placebo all the treatment groups were more effective except nifedipine and sildenafil. According to the SUCRA values obtained, naftopidil plus steroid was the highest rank and nifedipine lowest. For stone expulsion time (SET), compared with placebo only tadalafil plus silodosin, nifedipine plus steroid, alfuzosin, silodosin, tadalafil and tamsulosin were more effective. SUCRA values were highest for tadalafil plus silodosin and least for naftopidil plus steroid. From subgroup analysis with individual drugs for SER, SUCRA values were highest for naftopidil followed by silodosin and SET was highest for silodosin and least for naftopidil. CONCLUSION For lower ureter stone, tadalafil plus silodosin is the best combination and silodosin best individual drug considering the SET and SER. Nifedipine as monotherapy is no more effective than control group.
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Affiliation(s)
- Gopal Sharma
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pawan Kaundal
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarun Pareek
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shantanu Tyagi
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditya P Sharma
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudheer K Devana
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shrawan K Singh
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Falahatkar S, Akhavan A, Esmaeili S, Amin A, Kazemnezhad E, Jafari A. Efficacy of tamsulosin versus tadalafil as medical expulsive therapy on stone expulsion in patients with distal ureteral stones: A randomized double-blind clinical trial. Int Braz J Urol 2021; 47:982-988. [PMID: 34260175 PMCID: PMC8321460 DOI: 10.1590/s1677-5538.ibju.2020.1007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/21/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose: To compare the effects of tadalafil, tamsulosin, and placebo as a medical expulsive therapy (MET) for distal ureteral calculi. Materials and Methods: This prospective randomized double-blind clinical trial was conducted on 132 renal colic patients with distal ureteric stones (≤10mm) over a period of 12 months. Patients were randomly divided into three groups. Patients in group A received tamsulosin 0.4mg, in group B received tadalafil 10mg, and in group C received placebo. Therapy was given for a maximum of 4 weeks. The rate of stone expulsion, duration of stone expulsion, the dose and the duration of nonsteroidal anti-inflammatory drugs (NSAIDs), analgesic use, and adverse effects of drugs were recorded. Results: Demographic profiles were comparable between the 3 groups. Although the stone expulsion rate in group A (72.7%) was higher in comparison to group B(63.6%) and group C(56.8%), it was not considered statistically significant (P=0.294). Shorter mean time to stone expulsion was significantly observed in group A (17.75±75), than group B(21.13±1.17) and group C(22.25±1.18) (P=0.47). The mean number of analgesic use was 9.8±5.09 days in group A, 14.6±7.9 days in group B, and 12.6±22.25 days in group C, this difference was significant (P=0.004). The analgesic requirement (doses of NSAIDs and pethidine) in group A was significantly lower than other groups (P<0.05). Also, patients in group A reported fewer headaches compared to other groups (P=0.011). Conclusion: Tamsulosin as medical expulsive therapy is more effective for distal ureteric stones with less need for analgesics and less stone expulsion time than tadalafil.
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Affiliation(s)
- Siavash Falahatkar
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ardalan Akhavan
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Samaneh Esmaeili
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Atiyeh Amin
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnezhad
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Alireza Jafari
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Samir M, Elawady H, Hasan M. Efficacy and safety of silodosin, vardenafil versus silodosin in combination with vardenafil as a medical expulsive therapy for distal ureteric stones: a prospective randomized double-blind study. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00035-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Urolithiasis is considered one of the most common diseases in urological practice. Its prevalence is about 1% to 15% with 30 years old as the peak age of incidence. Medical expulsive therapy (MET) has been used as a conservative treatment for patients with ureteral stones. Nitrergic fibers have been identified to have a relaxant effect on the distal ureteral smooth musculature. The objective of our study was to evaluate the efficacy and safety of the combination of silodosin and vardenafil as a medical expulsive therapy in comparison with each drug alone.
Methods
One hundred and two male patients with uncomplicated distal ureteric stone 6–10 mm were enrolled in the study. The patients were randomly divided into 3 equal groups, and each one consists of 34 patients. Group I received silodosin 8 mg once daily, group II vardenafil 5 mg once daily and group III combination of silodosin 8 mg and vardenafil 5 mg once daily. The treatment was given for all the patients until stone expulsion or a maximum of 4 weeks. The primary endpoint was the stone expulsion rate, and the secondary endpoints were time to stone expulsion, number of hospital visits for pain, amount of analgesic required and side effects associated with MET.
Results
Our study showed that the stone expulsion rate was higher in combination = 90.0% than silodosin = 76.7% and vardenafil groups = 60.0% (P = 0.025), the time to stone expulsion was significantly shorter in combination = 11.23 ± 3.14 than silodosin = 12.50 ± 1.66 and vardenafil groups 14.67 ± 1.24 days (P < 0.01), the number of hospital visits for pain was statistically significant between the three groups (silodosin 1.35 ± 0.9, vardenafil 1.65 ± 1.09 and combination groups 1.02 ± 0.80) (P = 0.038) and lesser amount of analgesic required in combination 313.6 ± 2.85.5 than silodosin 613.44 ± 483.62 and vardenafil groups 716.97 ± 685.3 (P = 0.008). There was no significant difference among the studied groups as regards the drugs side effects except for retrograde ejaculation (silodosin and combination = 86.7% vs vardenafil groups = 0.0%) (P < 0.05) and increased erection (combination = 26.7%, vardenafil = 23.3% and silodosin groups = 0%) (P = 0.010).
Conclusion
The prescription of vardenafil in combination with silodosin is safe and more effective than silodosin or vardenafil alone as a MET.
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Efficacy of Tamsulosin plus Tadalafil versus Tamsulosin as Medical Expulsive Therapy for Lower Ureteric Stones: A Randomized Controlled Trial. Adv Urol 2020; 2020:4347598. [PMID: 32411212 PMCID: PMC7204220 DOI: 10.1155/2020/4347598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/15/2019] [Accepted: 01/08/2020] [Indexed: 01/01/2023] Open
Abstract
Introduction Urolithiasis is one of the common disorder with which about 1/5th is found in the ureter, of which 2/3rd is seen in the lower ureter. Medical expulsive therapy is one of the routine modalities of treatment which uses various drugs acting on the ureter smooth muscle by different mechanism. We aim to compare the efficacy of combination vs. single drug. Methods This randomized controlled trial was done in 176 consecutive patients over a period of six months (March 2019 to August 2019) in Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching. Participants were divided into two groups (Group A, tamsulosin plus tadalafil, and Group B, tamsulosin) from computer-generated random numbers. Therapy was continued for a maximum of 3 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of colic and emergency room visits for pain, early intervention, and adverse effects of drugs were recorded. Results Among 176 patients who were enrolled in study, 7 were lost to follow-up, and 5 people required immediate intervention. There was a significant higher stone passage rate in group A than group B (64 vs. 50; P=0.025) and shorter expulsion time (1.66 vs. 2.32 weeks P=0.001) and less number of emergency room visits and colic episodes. No significant side effects were noted during study. Conclusion Tamsulosin plus Tadalafil is more effective than tamsulosin with early passage of stone and decreased number of colic episodes and emergency visits without significant side effects for lower ureteric calculi of 5 mm to 10 mm.
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Liu H, Wang S, Zhu W, Lu J, Wang X, Yang W. Comparative efficacy of 22 drug interventions as medical expulsive therapy for ureteral stones: a systematic review and network meta-analysis. Urolithiasis 2019; 48:447-457. [DOI: 10.1007/s00240-019-01159-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 09/02/2019] [Indexed: 12/01/2022]
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Li JK, Qiu S, Jin K, Zheng XN, Tu X, Bi SW, Liao XY, Bao YG, Yang L, Wei Q. Efficacy and safety of phosphodiesterase type 5 inhibitors for the treatment of distal ureteral calculi of 5 to 10 mm in size: A systematic review and network meta-analysis. Kaohsiung J Med Sci 2019; 35:257-264. [PMID: 30897293 DOI: 10.1002/kjm2.12048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/09/2019] [Indexed: 02/05/2023] Open
Abstract
To evaluate the Efficacy and safety of phosphodiesterase type 5 inhibitors as a medical therapy for distal ureteral calculi by means of a systematic review and network meta-analysis (NMA). We searched the Embase, Medline, and the Cochrane Central Register of Controlled Trials for randomised controlled trials (RCTs) published before May, 2017. Stone passage rate as the primary outcome. We used random effects model for pairwise meta-analyses and Bayesian random effects model for NMA. We evaluated the quality of evidence by the GRADE framework for each network estimate. Five RCTs (861 patients) comparing four different interventions. The results of NMA showed that compared with tamsulosin alone, tamsulosin combined with tadalafil group was associated with significantly higher stone passage rate (odds radio [OR] 2.55, 95% credible intervals [Crl] 1.11 to 5.89). When considering stone expulsion rate, compared with tamsulosin, silodosin was ranked best (OR 3.58, 95% Crl 1.13 to 11.91), followed by tamsulosin combined with tadalafil (OR 2.55, 95% Crl 1.11 to 5.89) and tadalafil alone (OR 1.86, 95% Crl 0.95 to 4.25). No significant difference was found considering safety profiles between any interventions. This meta-analysis indicates that tamsulosin combined with tadalafil is an effective treatment option for ureteral stones with a low occurrence of side effects. Clinicians should take all known safety and compliance of patients into account when choosing an optimal strategy. Since sample size of included studies, further RCTs are strongly encouraged to address the clinical question.
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Affiliation(s)
- Jia-Kun Li
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China
| | - Shi Qiu
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China
| | - Kun Jin
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China
| | - Xiao-Nan Zheng
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China
| | - Xiang Tu
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China
| | - Si-Wei Bi
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China
| | - Xin-Yang Liao
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China
| | - Yi-Ge Bao
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China
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Sun X, Guan W, Liu H, Tang K, Yan L, Zhang Y, Zeng J, Chen Z, Xu H, Ye Z. Efficacy and safety of PDE5-Is and α-1 blockers for treating lower ureteric stones or LUTS: a meta-analysis of RCTs. BMC Urol 2018; 18:30. [PMID: 29724204 PMCID: PMC5934901 DOI: 10.1186/s12894-018-0345-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/23/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Lower ureteric stones and lower urinary tract symptoms are common in urology.Drug treatment is one of standard therapy,but the efficacy was controversial.Thus we aimed to investigate the efficacy and safety of monotherapy or combination therapy of adrenoceptor1 blockers and phosphodiesterase5 inhibitors for treatment. METHODS Randomized controlled trials up to November 2016 were retrieved from PubMed, the Cochrane Library, Web of Science and Embase. A total of 17 studies were included. We analyzed data through random or fixed effect models. The heterogeneity between studies was assessed by the I2 test statistic. RESULTS As for lower ureter stones, our analysis demonstrated tadalafil had a significantly lower incidence of abnormal ejaculation than adrenoceptor1 blockers (2.31 95%CI 0.22to0.84, P = 0.01),while combination therapy had a higher expulsion rate (2.49 95%CI 1.44to4.29, P = 0.001) and shorter expulsion time (- 1.98 95%CI -3.08to0.88, P = 0.0004) than tamsulosin. As for lower urinary tract symptoms, our analysis indicated adrenoceptor1 blockers was more effective than phosphodiesterase5 inhibitors on decreasing International Prostate Symptom Score (1.96 95%CI 0.03to3.89, P = 0.05) and Post-Void Residual (9.41 95%CI 1.40to14.41, P = 0.02) and phosphodiesterase5 inhibitors showed a greater effect than adrenoceptor1 blockers on improving Erectile Dysfunction (2.23 95%CI 1.24to3.22, P<0.0001).Combination therapy had a significantly better effect on International Prostate Symptom Score (1.47 95%CI 1.25to1.69, P<0.0001), Maximum flow rate (0.87 95%CI 0.71to1.04, P<0.0001), Post-Void Residual (10.74 95%CI 3.53to17.96,P = 0.004) and Quality of life (0.59 95%CI 0.22to0.97, P = 0.002) but was associated with higher incidences of adverse events (3.40 95%CI 1.82to6.36, P = 0.0001) than adrenoceptor1 blockers. Combination therapy had a significantly better effect on International Prostate Symptom Score (4.19 95%CI 3.34to5.04, P<0.0001), Maximum flow rate (1.86 95%CI 1.32to2.39, P<0.0001), Post-Void Residual (22.58 95%CI 9.13to36.04, P = 0.001) and Quality of life (0.68 95%CI 0.37to1.00, P<0.0001) without higher incidences of adverse events than PDE5-Is. CONCLUSIONS In conclusion, this meta-analysis suggested combination therapy had a best efficacy of therapy for lower ureteric stones or lower urinary tract symptoms correlated with benign prostatic hyperplasia than monotherapy. Adrenoceptor1 blockers was more effective than phosphodiesterase5 inhibitors on International Prostate Symptom Score and Post-Void Residual. Both monotherapy and combination therapy were safe.
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Affiliation(s)
- Xifeng Sun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Institute of Urology of Hubei Province, Wuhan, 430030, China
| | - Wei Guan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Haoran Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Institute of Urology of Hubei Province, Wuhan, 430030, China
| | - Kun Tang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Institute of Urology of Hubei Province, Wuhan, 430030, China
| | - Libin Yan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Institute of Urology of Hubei Province, Wuhan, 430030, China
| | - Yangjun Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Institute of Urology of Hubei Province, Wuhan, 430030, China
| | - Jin Zeng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Institute of Urology of Hubei Province, Wuhan, 430030, China
| | - Zhiqiang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Institute of Urology of Hubei Province, Wuhan, 430030, China
| | - Hua Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. .,Institute of Urology of Hubei Province, Wuhan, 430030, China.
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Institute of Urology of Hubei Province, Wuhan, 430030, China
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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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Kang HW, Seo SP, Kim WT, Kim YJ, Yun SJ, Kim WJ, Lee SC. Metabolic Characteristics and Risks Associated with Stone Recurrence in Korean Young Adult Stone Patients. J Endourol 2017; 31:806-811. [DOI: 10.1089/end.2017.0210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Ho Won Kang
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, South Korea
- Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Sung Pil Seo
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, South Korea
- Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Won Tae Kim
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, South Korea
- Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Yong-June Kim
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, South Korea
- Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Seok-Joong Yun
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, South Korea
- Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Wun-Jae Kim
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, South Korea
- Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Sang-Cheol Lee
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, South Korea
- Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea
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Bai Y, Yang Y, Wang X, Tang Y, Han P, Wang J. Tadalafil Facilitates the Distal Ureteral Stone Expulsion: A Meta-Analysis. J Endourol 2017; 31:557-563. [PMID: 28384011 DOI: 10.1089/end.2016.0837] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To assess the efficacy and safety of tadalafil in facilitating the spontaneous passage of distal ureteral stones. METHODS The relevant studies were identified by searching MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials up to November 2016. Randomized controlled trials evaluating effects of tadalafil for distal ureteral stones were included. RESULTS Six publications involving 921 patients were included. Compared with tamsulosin monotherapy, tadalafil monotherapy or combined with tamsulosin has a significantly higher stone expulsion rate (relative risk [RR], 1.16; 95% confidence interval [CI], 1.05 to 1.29; p = 0.004; RR, 1.24; 95% CI, 1.09 to 1.42; p = 0.001, respectively) and shorter time to stone expulsion (mean difference [MD], -1.33 days; 95% CI, -2.44 to -0.23; p = 0.02; MD, -1.98 days; 95% CI, -3.08 to -0.88; p = 0.0004, respectively). Statistically significant differences were noted in pain episodes and analgesic use in favor of group tadalafil alone compared to group tamsulosin alone. The analgesic use was significantly lower in the combined group than in the tamsulosin alone group. Although the occurrence of drug-related adverse events in the tadalafil alone or combined with tamsulosin was higher than that in the use of tamsulosin-alone group, the most common adverse events were mild and tolerable. CONCLUSIONS Our study suggested that medical expulsive therapy for the distal ureteral stones using tadalafil alone or combined with tamsulosin is safe, efficacious, and well tolerated.
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Affiliation(s)
- Yunjin Bai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University , Chengdu, China
| | - Yubo Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University , Chengdu, China
| | - Xiaoming Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University , Chengdu, China
| | - Yin Tang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University , Chengdu, China
| | - Ping Han
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University , Chengdu, China
| | - Jia Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University , Chengdu, China
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