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Efficacy and Safety of Alfuzosin as Medical Expulsive Therapy for Ureteral Stones: A Systematic Review and Meta-Analysis.

Liu C, Zeng G, Kang R, Wu W, Li J, Chen K, Wan SP - PLoS ONE (2015)

Bottom Line: It is more effective than therapeutic regiment without alpha blocker.It is equivalent to Tamsulosin in its effectiveness and safety profile.Adverse effects should always be kept in mind when use this class of drugs.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangdong, China.

ABSTRACT

Background: Alfuzosin has been widely used to treat benign prostatic hyperplasia and prostatitis, and is claimed to be a selective agent for the lower urinary tract with low incidence of adverse side-effects and hypotensive changes. Recently, several randomized controlled trials have reported using Alfuzosin as an expulsive therapy of ureteral stones. Tamsulosin, another alpha blocker, has also been used as an agent for the expulsive therapy for ureteral stones. It is unclear whether alfuzosin has similar efficacy as Tamsulosin in the management of ureteral stones.

Objective: To perform a systematic review and analysis of literatures comparing Alfuzosin with Tamsulosin or standard conservative therapy for the treatment of ureteral stones less than 10 mm in diameter.

Methods: A systematic literature review was performed in December 2014 using Pubmed, Embase, and the Cochrane library databases to identify relevant studies. All randomized and controlled trials were included. A subgroup analysis was performed comparing Alfuzosin with control therapy on the management of distal ureteral stones.

Results: Alfuzosin provided a significantly higher stone-free rate than the control treatments (RR: 1.85; 95% confidence interval [CI], 1.35-2.55; p<0.001), and a shorter stone expulsion time (Weighted mean difference [WMD]: -4.20 d, 95%CI, -6.19 to -2.21; p<0.001), but it has a higher complication rate (RR: 2.02; 95% CI, 1.30-3.15; p<0.01). When Alfuzosin was compared to Tamsulosin, there was no significant difference in terms of stone-free rate (RR: 0.90; 95% CI, 0.79-1.02; p = 0.09) as well as the stone expulsion time (WMD: 0.52 d, 95%CI, -1.61 to 2.64; p = 0.63). The adverse effects of Alfuzosin were similar to those of Tamsulosin (RR: 0.88; 95% CI, 0.61-1.26; p = 0.47).

Conclusions: Alfuzosin is a safe and effective agent for the expulsive therapy of ureteral stones smaller than 10 mm in size. It is more effective than therapeutic regiment without alpha blocker. It is equivalent to Tamsulosin in its effectiveness and safety profile. Adverse effects should always be kept in mind when use this class of drugs.

No MeSH data available.


Related in: MedlinePlus

Forest plot of Alfuzosin versus control therapy.The central square of each horizontal line represents the RR or WMD for each study. The lines demonstrate the range of the 95% CI. The vertical line at an RR of 1 or at WMD of 0 is the line of no effect. % Weight indicates the influence exerted by each study on the pooled RR or WMD. CI = confidence interval; M-H = Mantel-Haenszel; IV = inverse variance; SD = standard deviation.
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pone.0134589.g002: Forest plot of Alfuzosin versus control therapy.The central square of each horizontal line represents the RR or WMD for each study. The lines demonstrate the range of the 95% CI. The vertical line at an RR of 1 or at WMD of 0 is the line of no effect. % Weight indicates the influence exerted by each study on the pooled RR or WMD. CI = confidence interval; M-H = Mantel-Haenszel; IV = inverse variance; SD = standard deviation.

Mentions: There was a significantly higher stone expulsion rate following treatment with Alfuzosin as compared with control therapy (RR: 1.85; 95%CI, 1.35, 2.55; p<0.001). Alfuzosin also provided a shorter stone expulsion time (WMD: -4.20 d, 95%CI, -6.19 to -2.21; p<0.001). The pooled effect of adverse events reported by seven studies showed a higher complication rate for Alfuzosin treatment (RR: 2.02; 95% CI, 1.30–3.15; p<0.01). However, there was no significant difference between the two treatments in terms of pain episodes (WMD: -0.68, 95%CI, -1.48 to 0.01; p = 0.05) (Fig 2). The chi-square statistic for heterogeneity was significant (33.52 with df 8, p<0.0001, and I2 = 76%). The funnel plot was asymmetrical (Fig 3).


Efficacy and Safety of Alfuzosin as Medical Expulsive Therapy for Ureteral Stones: A Systematic Review and Meta-Analysis.

Liu C, Zeng G, Kang R, Wu W, Li J, Chen K, Wan SP - PLoS ONE (2015)

Forest plot of Alfuzosin versus control therapy.The central square of each horizontal line represents the RR or WMD for each study. The lines demonstrate the range of the 95% CI. The vertical line at an RR of 1 or at WMD of 0 is the line of no effect. % Weight indicates the influence exerted by each study on the pooled RR or WMD. CI = confidence interval; M-H = Mantel-Haenszel; IV = inverse variance; SD = standard deviation.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4526635&req=5

pone.0134589.g002: Forest plot of Alfuzosin versus control therapy.The central square of each horizontal line represents the RR or WMD for each study. The lines demonstrate the range of the 95% CI. The vertical line at an RR of 1 or at WMD of 0 is the line of no effect. % Weight indicates the influence exerted by each study on the pooled RR or WMD. CI = confidence interval; M-H = Mantel-Haenszel; IV = inverse variance; SD = standard deviation.
Mentions: There was a significantly higher stone expulsion rate following treatment with Alfuzosin as compared with control therapy (RR: 1.85; 95%CI, 1.35, 2.55; p<0.001). Alfuzosin also provided a shorter stone expulsion time (WMD: -4.20 d, 95%CI, -6.19 to -2.21; p<0.001). The pooled effect of adverse events reported by seven studies showed a higher complication rate for Alfuzosin treatment (RR: 2.02; 95% CI, 1.30–3.15; p<0.01). However, there was no significant difference between the two treatments in terms of pain episodes (WMD: -0.68, 95%CI, -1.48 to 0.01; p = 0.05) (Fig 2). The chi-square statistic for heterogeneity was significant (33.52 with df 8, p<0.0001, and I2 = 76%). The funnel plot was asymmetrical (Fig 3).

Bottom Line: It is more effective than therapeutic regiment without alpha blocker.It is equivalent to Tamsulosin in its effectiveness and safety profile.Adverse effects should always be kept in mind when use this class of drugs.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangdong, China.

ABSTRACT

Background: Alfuzosin has been widely used to treat benign prostatic hyperplasia and prostatitis, and is claimed to be a selective agent for the lower urinary tract with low incidence of adverse side-effects and hypotensive changes. Recently, several randomized controlled trials have reported using Alfuzosin as an expulsive therapy of ureteral stones. Tamsulosin, another alpha blocker, has also been used as an agent for the expulsive therapy for ureteral stones. It is unclear whether alfuzosin has similar efficacy as Tamsulosin in the management of ureteral stones.

Objective: To perform a systematic review and analysis of literatures comparing Alfuzosin with Tamsulosin or standard conservative therapy for the treatment of ureteral stones less than 10 mm in diameter.

Methods: A systematic literature review was performed in December 2014 using Pubmed, Embase, and the Cochrane library databases to identify relevant studies. All randomized and controlled trials were included. A subgroup analysis was performed comparing Alfuzosin with control therapy on the management of distal ureteral stones.

Results: Alfuzosin provided a significantly higher stone-free rate than the control treatments (RR: 1.85; 95% confidence interval [CI], 1.35-2.55; p<0.001), and a shorter stone expulsion time (Weighted mean difference [WMD]: -4.20 d, 95%CI, -6.19 to -2.21; p<0.001), but it has a higher complication rate (RR: 2.02; 95% CI, 1.30-3.15; p<0.01). When Alfuzosin was compared to Tamsulosin, there was no significant difference in terms of stone-free rate (RR: 0.90; 95% CI, 0.79-1.02; p = 0.09) as well as the stone expulsion time (WMD: 0.52 d, 95%CI, -1.61 to 2.64; p = 0.63). The adverse effects of Alfuzosin were similar to those of Tamsulosin (RR: 0.88; 95% CI, 0.61-1.26; p = 0.47).

Conclusions: Alfuzosin is a safe and effective agent for the expulsive therapy of ureteral stones smaller than 10 mm in size. It is more effective than therapeutic regiment without alpha blocker. It is equivalent to Tamsulosin in its effectiveness and safety profile. Adverse effects should always be kept in mind when use this class of drugs.

No MeSH data available.


Related in: MedlinePlus