Medical expulsive therapy for ureteric stones: Analysing the evidence from systematic reviews and meta-analysis of powered double-blinded randomised controlled trials.

OBJECTIVE: To conduct a systematic review and meta-analysis investigating the efficacy and safety of medical expulsive therapy (MET) in low risk of bias (RoB) randomised controlled trials (RCTs).

METHODS: A Cochrane style systematic review was conducted on published literature from 1990 to 2016, to include low RoB and a power calculation. A pooled meta-analysis was conducted.

RESULTS: The MET group included 1387 vs 1381 patients in the control group. The analysis reveals α-blockers increased stone expulsion rates (78% vs 74%) ( P  < 0.001), whilst calcium channel blockers (CCBs) had no effect compared to controls (79% vs 75%) ( P  = 0.38). In the subgroup analysis, α-blockers had a shorter time to stone expulsion vs the control group ( P  < 0.001). There were no significant differences in expulsion rates between the treatment groups and control group for stones <5 mm in size ( P  = 0.48), proximal or mid-ureteric stones ( P  = 0.63 and P  = 0.22, respectively). However, α-blockers increased stone expulsion in stones >5 mm ( P  = 0.02), as well as distal ureteric stones ( P  < 0.001). The α-blocker group developed more side-effects (6.6% of patients; P  < 0.001). The numbers needed to treat for α-blockers was one in 14, for stones >5 mm one in eight, and for distal stones one in 10.

CONCLUSION: The primary findings show a small overall benefit for α-blockers as MET for ureteric stones but no benefit with CCBs. α-blockers show a greater benefit for large (>5 mm) ureteric stones and those located in the distal ureter, but no benefit for smaller or more proximal stones. α-blockers are associated with a greater risk of side-effects compared to placebo or CCBs.