Tamsulosin As Medical Expulsive Therapy For Lower Ureterolithiasis:a Meta-analysis

Objective: To review the evidence fortamsulosin as medical expulsivetherapy in enhancing the effectiveness of distal ureteral stone clearance rate.Methods: We searched Pubmed/Medline, Embase, CBM and the CochraneLibrary up to October2011. All randomized controlled trials in whichtamsulosin was evaluated with distal ureterolithiasis were eligible for theanalysis. Outcome measure assessed was stone clearance rate. Two authorsindependently assessed study quality and extracted data. All data wereanalyzed using RevMan5.1. Results: Thirteen studies involving1067participants met the inclusion criteria. Study duration ranged from7to42d.The pooled analysis showed an improvement of41%in stone clearancerate of tamsulosin as medical expulsive therapy for distal ureteral calculi(RR=1.41,95%CI=1.18to1.70). According to stone size (6mm<size<10mm,5mm<size<6mm, size <5mm), the pooling effects of tamsulosinwere analyzed, with a higher stone expulsion rate obtained than control(RR=1.52,1.75,1.05,95%CI=1.30to1.77,1.25to2.45,0.95to1.16,respectively). Adverse effects of tamsulosin, mainly retrograde ejaculation, dizziness and hypotension, were reported in8included trials. Conclusion:Treatment with tamsulosin appears to be a safe and effective medicalexpulsion therapy for distal ureterolithiasis. To make a definite clinicalrecommendation to use tamsulosin as medical expulsive treatment for distalureteral calculi, high quality multicentric, randomized, double blinded,controlled trials are necessary to prove its efficacy.