Systematic review and meta-analysis of the adjuvant role of Medical Expulsive Therapy (MET) in Shock Wave Lithotripsy (SWL) treatment of upper urinary stones

Nikolaos Grivas, Panagiotis Kallidonis, Panagiotis Mourmouris, Thomas Rountos, Alexandros Fiamegos, Sotirios Stavrou, Chris Venetis, Andreas Skolarikos, The Members of RISTA Study Group The Members of RISTA Study Group

Abstract


Introduction: Medical expulsion therapy (MET) has been introduced
as a method enhancing the spontaneous passage of
stones and reducing the stone expulsion time after extracorporeal
shockwave lithotripsy (SWL). The aim of the current
meta-analysis was to analyze the data of randomized studies on
MET implemented following SWL for renal and ureteral stones.
Materials and Methods: A systematic literature search of CENTRAL,
WEB OF SCIENCE, PUBMED and SCOPUS was performed.
The criteria applied for the selection of the included studies
were: randomized, placebo or other comparator (i.e analgesics)
controlled studies dealing with renal or ureteral stones treated
with SWL and MET (including plant extracts) with a minimum follow-up of 14 days. Subgroup analyses were a priori planned
to be performed depending on the: type of α-blocker (i.e tamsulosin,
alfuzosin, terazosin, doxazosin, Urapidil), size and location
of stones. All results were combined for meta-analysis with the
Review Manager.
Results: 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 auxillary procedures
were reduced mainly with α-blockers. Expulsion rate was
not correlated with the type of α-blocker, the stone diameter
and the stone location.
Conclusions: Evidence suggests that MET can be suggested as
an adjuvant treatment after SWL due to its expulsive efficacy,
pain reduction and safety profile. However, due to the clinical
heterogeneity among the included studies, conclusions drawn

Keywords


ESWL; pharmaceutical adjuvants; renal calculi; ureteral calculi

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DOI: http://dx.doi.org/10.19264/hj.v31i1.257