Which combination of medical expulsive therapy is more effective for treatment of distal ureteral stone in adults? A systematic review and network meta-analysis
Abstract Background Medical Expulsive Therapy (MET) has been recommended as an established modality for the treatment of distal ureteral stones due to its clearance rate, pain control, and patient satisfaction while having minimal morbidity in comparison to other urologic interventions. In some stud...
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2025-01-01
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| Series: | BMC Urology |
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| Online Access: | https://doi.org/10.1186/s12894-024-01679-2 |
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| author | Maryam Taheri Nasrin Borumandnia Hamidreza Abdi Amir H Kashi Setareh Nourani Sogand Sheikholeslami Yasamin Maleki Gilvaei Pardis Ziaeefar Abbas Basiri |
| author_facet | Maryam Taheri Nasrin Borumandnia Hamidreza Abdi Amir H Kashi Setareh Nourani Sogand Sheikholeslami Yasamin Maleki Gilvaei Pardis Ziaeefar Abbas Basiri |
| author_sort | Maryam Taheri |
| collection | DOAJ |
| description | Abstract Background Medical Expulsive Therapy (MET) has been recommended as an established modality for the treatment of distal ureteral stones due to its clearance rate, pain control, and patient satisfaction while having minimal morbidity in comparison to other urologic interventions. In some studies, a combination of medications has been used, which we assessed in this network meta-analysis (NMA). Methods We conducted systematic searches in PubMed, Scopus, and Web of Science to identify relevant trials published between 2001 and 2024. We excluded articles that looked at MET for upper ureteral stone passage or after shock wave lithotripsy (SWL). NMA was performed to compare the effect of combination MET on stone expulsion rate (SER), stone expulsion time (SET), and need for analgesia. Results We included 19 studies with 2414 participants. NMA results revealed that the combination MET of α-blockers with PDE-5 inhibitors (OR = 2.7, CI = 1.80,4.05), corticosteroids (OR = 2.7, CI = 1.81,4.13), and phytotherapy (OR: 3.10, CI = 1.62,5.92) were more effective than α-blockers alone in SER. The combination MET of α-blockers with PDE-5 inhibitors (MD: -3.8, CI=-7.0, -0.5) showed significantly lower SET compared to α-blockers alone. Finally, combination MET of α-blockers with PDE-5 inhibitors (MD:1.0, CI = 0.4,1.7) and nifedipine with corticosteroids (MD:1.2, CI = 0.4,1.9) showed a significant decrease in analgesia use. Conclusions The combination MET of α-blockers with PDE-5 inhibitors, corticosteroids, and phytotherapy increases the rate of stone clearance 2.7 to 3.1 times more than α-blockers alone. The other benefits of combination MET were lower expulsion time and less analgesia use that needs further studies. |
| format | Article |
| id | doaj-art-97f9b996f6a1481dba211acb7056ae40 |
| institution | Kabale University |
| issn | 1471-2490 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | BMC Urology |
| spelling | doaj-art-97f9b996f6a1481dba211acb7056ae402025-02-02T12:44:19ZengBMCBMC Urology1471-24902025-01-0125111110.1186/s12894-024-01679-2Which combination of medical expulsive therapy is more effective for treatment of distal ureteral stone in adults? A systematic review and network meta-analysisMaryam Taheri0Nasrin Borumandnia1Hamidreza Abdi2Amir H Kashi3Setareh Nourani4Sogand Sheikholeslami5Yasamin Maleki Gilvaei6Pardis Ziaeefar7Abbas Basiri8Urology and Nephrology Research Center, Research Institute for Urology and Nephrology, Shahid Beheshti University of Medical SciencesUrology and Nephrology Research Center, Research Institute for Urology and Nephrology, Shahid Beheshti University of Medical SciencesDepartment of Surgery, Western UniversityUrology and Nephrology Research Center (UNRC), Research Institute for Urology and Nephrology, Center of Excellence in Urology, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences (SBMU)School of Medicine, Lorestan University of Medical SciencesStudent Research Committee, Hamadan University of Medical SciencesSchool of Medicine, Tehran University of Medical SciencesUrology and Nephrology Research Center, Research Institute for Urology and Nephrology, Shahid Beheshti University of Medical SciencesUrology and Nephrology Research Center (UNRC), Research Institute for Urology and Nephrology, Center of Excellence in Urology, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences (SBMU)Abstract Background Medical Expulsive Therapy (MET) has been recommended as an established modality for the treatment of distal ureteral stones due to its clearance rate, pain control, and patient satisfaction while having minimal morbidity in comparison to other urologic interventions. In some studies, a combination of medications has been used, which we assessed in this network meta-analysis (NMA). Methods We conducted systematic searches in PubMed, Scopus, and Web of Science to identify relevant trials published between 2001 and 2024. We excluded articles that looked at MET for upper ureteral stone passage or after shock wave lithotripsy (SWL). NMA was performed to compare the effect of combination MET on stone expulsion rate (SER), stone expulsion time (SET), and need for analgesia. Results We included 19 studies with 2414 participants. NMA results revealed that the combination MET of α-blockers with PDE-5 inhibitors (OR = 2.7, CI = 1.80,4.05), corticosteroids (OR = 2.7, CI = 1.81,4.13), and phytotherapy (OR: 3.10, CI = 1.62,5.92) were more effective than α-blockers alone in SER. The combination MET of α-blockers with PDE-5 inhibitors (MD: -3.8, CI=-7.0, -0.5) showed significantly lower SET compared to α-blockers alone. Finally, combination MET of α-blockers with PDE-5 inhibitors (MD:1.0, CI = 0.4,1.7) and nifedipine with corticosteroids (MD:1.2, CI = 0.4,1.9) showed a significant decrease in analgesia use. Conclusions The combination MET of α-blockers with PDE-5 inhibitors, corticosteroids, and phytotherapy increases the rate of stone clearance 2.7 to 3.1 times more than α-blockers alone. The other benefits of combination MET were lower expulsion time and less analgesia use that needs further studies.https://doi.org/10.1186/s12894-024-01679-2Alpha-blockersDrug combinationKidney stoneMedical expulsive therapyUreterolithiasis |
| spellingShingle | Maryam Taheri Nasrin Borumandnia Hamidreza Abdi Amir H Kashi Setareh Nourani Sogand Sheikholeslami Yasamin Maleki Gilvaei Pardis Ziaeefar Abbas Basiri Which combination of medical expulsive therapy is more effective for treatment of distal ureteral stone in adults? A systematic review and network meta-analysis BMC Urology Alpha-blockers Drug combination Kidney stone Medical expulsive therapy Ureterolithiasis |
| title | Which combination of medical expulsive therapy is more effective for treatment of distal ureteral stone in adults? A systematic review and network meta-analysis |
| title_full | Which combination of medical expulsive therapy is more effective for treatment of distal ureteral stone in adults? A systematic review and network meta-analysis |
| title_fullStr | Which combination of medical expulsive therapy is more effective for treatment of distal ureteral stone in adults? A systematic review and network meta-analysis |
| title_full_unstemmed | Which combination of medical expulsive therapy is more effective for treatment of distal ureteral stone in adults? A systematic review and network meta-analysis |
| title_short | Which combination of medical expulsive therapy is more effective for treatment of distal ureteral stone in adults? A systematic review and network meta-analysis |
| title_sort | which combination of medical expulsive therapy is more effective for treatment of distal ureteral stone in adults a systematic review and network meta analysis |
| topic | Alpha-blockers Drug combination Kidney stone Medical expulsive therapy Ureterolithiasis |
| url | https://doi.org/10.1186/s12894-024-01679-2 |
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