Journal of Endourology he efficacy and safety of tamsulosin combined with extracorporeal shockwave lithotripsy for urolithiasis: A systematic review and meta-analysis of Randomized Controlled Trials (doi: 10.1089/end.2015.0098 This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
Page 1 of 24
1 Title page
The efficacy and safety of tamsulosin combined with extracorporeal shockwave lithotripsy for urolithiasis: A systematic review and meta-analysis of Randomized Controlled Trials Kai Chen 1, *†Hua Mi 2,* Guangyu Xu1, Lin Liu3# ,Xiubin Sun1, Shiping Wang1, Qingrong Meng1, Tao Lv1,
#Lin Liu (This author provides substantial contributions to revising article critically for important
intellectual content in our revised manuscript ,and should be listed as co-authors) 1. Department of Urology, The People’s Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College, Shandong Province, China 2. Institute of Urology and Nephrology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China 3. Department of Oncology, The People’s Hospital of AnQiu City, Shandong Province, China
* Kai Chen and Hua Mi have contributed equally to this work and should be considered as co-first authors.
Running title: Tamsulosin combined with SWL for urolithiasis †Corresponding author: Kai Chen. E-mail: [email protected]. Department of Urology, The People’s Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College, Shandong Province 271100, P. R. China. Tel: +86 634 6279043. Fax: +86 634 6279043.
1
Journal of Endourology he efficacy and safety of tamsulosin combined with extracorporeal shockwave lithotripsy for urolithiasis: A systematic review and meta-analysis of Randomized Controlled Trials (doi: 10.1089/end.2015.0098 This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
Page 2 of 24
2 Abstract Objectives: Many studies have been conducted to investigate the adjunctive tamsulosin therapy after Extracorporeal shockwave lithotripsy (SWL) for urolithiasis. However, the results from those studies are still inconsistent. Therefore, we performed a meta-analysis to provide an update on the clinical efficacy and safety of tamsulosin combined with SWL for urolithiasis. Methods: A systematic search was performed in PubMed, Cochrane Library, and Embase to identify all relevant randomized controlled trials (RCTs) until January 2015. Two reviewers independently assessed trial quality and extracted data. Meta-analysis was conducted with Review Manager (RevMan) version 5.1. Results: Twenty-one studies (2093 subjects in total) were identified in the current meta-analysis. Compared with control group, Experimental group (tamsulosin combined with SWL) showed an increased overall benefit for stone expulsion, with pooled RR of 1.22 [95% CI, 1.16 -1.29]1.20 [95% CI, 1.15 -1.26]. With respect to the different ethnicities geographic regions, European and American had a high possibility of improvement in stone expulsion (RR: 1.33, 95% CI,1.19- 1.49).According to stone locations (renal, upper and lower ureteral) and sizes (4-10 mm and 11–24 mm), tamsulosin are more useful for lower ureteral stone (RR: 1.28; 95% CI, 1.14 -1.43) and stone with a larger sizes (RR:1.49; 95% CI, 1.28-1.75). The effect estimates did not vary markedly when stratified by
follow-up durations but varied by dose of tamsulosin. (New added)Furthermore, a shorter expulsion time, reduced occurrence of steinstrasse, fewer incidences of colic, and lower analgesic requirements were observed within experimental group. In addition, tamsulosin is well tolerated and its adverse events rarely led to dropouts of patients. Conclusions: Overall, evidence suggests that tamsulosin combined with SWL is safe and effective in enhancing stone expulsion for patients with urolithiasis. Furthermore, high-quality, randomized and placebo-controlled trials evaluating the efficacy and safety of tamsulosin should be performed.
2
Journal of Endourology he efficacy and safety of tamsulosin combined with extracorporeal shockwave lithotripsy for urolithiasis: A systematic review and meta-analysis of Randomized Controlled Trials (doi: 10.1089/end.2015.0098 This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
Page 3 of 24
3
Introduction Urolithiasis affects 4% to 15% of the world population, and the incidence of this disease is increasing in recent decades1,2. The treatment of this pathology was revolutionized with the introduction, in the late 1980s, of Extracorporeal shockwave lithotripsy (SWL), a non-invasive technology that has become one of the recommended form of treatment for urolithiasis
Page 1 of 24
1 Title page
The efficacy and safety of tamsulosin combined with extracorporeal shockwave lithotripsy for urolithiasis: A systematic review and meta-analysis of Randomized Controlled Trials Kai Chen 1, *†Hua Mi 2,* Guangyu Xu1, Lin Liu3# ,Xiubin Sun1, Shiping Wang1, Qingrong Meng1, Tao Lv1,
#Lin Liu (This author provides substantial contributions to revising article critically for important
intellectual content in our revised manuscript ,and should be listed as co-authors) 1. Department of Urology, The People’s Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College, Shandong Province, China 2. Institute of Urology and Nephrology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China 3. Department of Oncology, The People’s Hospital of AnQiu City, Shandong Province, China
* Kai Chen and Hua Mi have contributed equally to this work and should be considered as co-first authors.
Running title: Tamsulosin combined with SWL for urolithiasis †Corresponding author: Kai Chen. E-mail: [email protected]. Department of Urology, The People’s Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College, Shandong Province 271100, P. R. China. Tel: +86 634 6279043. Fax: +86 634 6279043.
1
Journal of Endourology he efficacy and safety of tamsulosin combined with extracorporeal shockwave lithotripsy for urolithiasis: A systematic review and meta-analysis of Randomized Controlled Trials (doi: 10.1089/end.2015.0098 This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
Page 2 of 24
2 Abstract Objectives: Many studies have been conducted to investigate the adjunctive tamsulosin therapy after Extracorporeal shockwave lithotripsy (SWL) for urolithiasis. However, the results from those studies are still inconsistent. Therefore, we performed a meta-analysis to provide an update on the clinical efficacy and safety of tamsulosin combined with SWL for urolithiasis. Methods: A systematic search was performed in PubMed, Cochrane Library, and Embase to identify all relevant randomized controlled trials (RCTs) until January 2015. Two reviewers independently assessed trial quality and extracted data. Meta-analysis was conducted with Review Manager (RevMan) version 5.1. Results: Twenty-one studies (2093 subjects in total) were identified in the current meta-analysis. Compared with control group, Experimental group (tamsulosin combined with SWL) showed an increased overall benefit for stone expulsion, with pooled RR of 1.22 [95% CI, 1.16 -1.29]1.20 [95% CI, 1.15 -1.26]. With respect to the different ethnicities geographic regions, European and American had a high possibility of improvement in stone expulsion (RR: 1.33, 95% CI,1.19- 1.49).According to stone locations (renal, upper and lower ureteral) and sizes (4-10 mm and 11–24 mm), tamsulosin are more useful for lower ureteral stone (RR: 1.28; 95% CI, 1.14 -1.43) and stone with a larger sizes (RR:1.49; 95% CI, 1.28-1.75). The effect estimates did not vary markedly when stratified by
follow-up durations but varied by dose of tamsulosin. (New added)Furthermore, a shorter expulsion time, reduced occurrence of steinstrasse, fewer incidences of colic, and lower analgesic requirements were observed within experimental group. In addition, tamsulosin is well tolerated and its adverse events rarely led to dropouts of patients. Conclusions: Overall, evidence suggests that tamsulosin combined with SWL is safe and effective in enhancing stone expulsion for patients with urolithiasis. Furthermore, high-quality, randomized and placebo-controlled trials evaluating the efficacy and safety of tamsulosin should be performed.
2
Journal of Endourology he efficacy and safety of tamsulosin combined with extracorporeal shockwave lithotripsy for urolithiasis: A systematic review and meta-analysis of Randomized Controlled Trials (doi: 10.1089/end.2015.0098 This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
Page 3 of 24
3
Introduction Urolithiasis affects 4% to 15% of the world population, and the incidence of this disease is increasing in recent decades1,2. The treatment of this pathology was revolutionized with the introduction, in the late 1980s, of Extracorporeal shockwave lithotripsy (SWL), a non-invasive technology that has become one of the recommended form of treatment for urolithiasis
