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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

Funnel plot of Alfuzosin versus control therapy.Funnel plot for evaluation of publication bias. Vertical solid line represents the logarithmic transformation of the overall estimated treatment effect (ie, log [RR]), diagonal dotted lines represent pseudo–95% confidence limits for estimated treatment effect, and the circles represent treatment effects of each of the 9 studies. In the absence of publication bias, graph should represent a funnel, with individual studies clustered around the overall estimated treatment effect symmetrically.
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pone.0134589.g003: Funnel plot of Alfuzosin versus control therapy.Funnel plot for evaluation of publication bias. Vertical solid line represents the logarithmic transformation of the overall estimated treatment effect (ie, log [RR]), diagonal dotted lines represent pseudo–95% confidence limits for estimated treatment effect, and the circles represent treatment effects of each of the 9 studies. In the absence of publication bias, graph should represent a funnel, with individual studies clustered around the overall estimated treatment effect symmetrically.

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)

Funnel plot of Alfuzosin versus control therapy.Funnel plot for evaluation of publication bias. Vertical solid line represents the logarithmic transformation of the overall estimated treatment effect (ie, log [RR]), diagonal dotted lines represent pseudo–95% confidence limits for estimated treatment effect, and the circles represent treatment effects of each of the 9 studies. In the absence of publication bias, graph should represent a funnel, with individual studies clustered around the overall estimated treatment effect symmetrically.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0134589.g003: Funnel plot of Alfuzosin versus control therapy.Funnel plot for evaluation of publication bias. Vertical solid line represents the logarithmic transformation of the overall estimated treatment effect (ie, log [RR]), diagonal dotted lines represent pseudo–95% confidence limits for estimated treatment effect, and the circles represent treatment effects of each of the 9 studies. In the absence of publication bias, graph should represent a funnel, with individual studies clustered around the overall estimated treatment effect symmetrically.
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