Efficacy of α-blocker in improving ureteral stent-related symptoms: a meta-analysis of both direct and indirect comparison

Figures & data

Table 1 Baseline characteristics of included RCTs

Study	Year	Case (T/C, n)	Age (T/C, y)	Sex (male/female)		Intervention (T/C)	Duration	Stent (size/length, cm)	Outcome measured time
				T	C
Deliveliotis et al^Citation11	2006	50/50	53.1/55.3	30/20	27/23	10 mg alfuzosin for 4 weeks/placebo	4 weeks	5F/26–28	PI 4 weeks
Damiano et al^Citation12	2008	38/37	–	29/46		0.4 mg tamsulosin for 4 weeks/control	2 weeks	7F/−	PI and PR 1 week
Beddingfield et al^Citation13	2009	26/29	45.8/44.0	7/19	16/13	10 mg alfuzosin for 8 days/placebo	8.3/11.5 days	–	PI 3 days
Wang et al^Citation14	2009	79/75	50.1/51.5	63/16	58/17	0.4 mg tamsulosin for 2 weeks/placebo	2 weeks	7F/−	PI 1 week, and PR 2 weeks
Wang et al^Citation15	2009	75/71	50.4/50.8	61/14	55/16	0.4 mg tamsulosin for 2 weeks/placebo	2 weeks	7F/26	PI 2 weeks
Navanimitkul and Lojanapiwat^Citation16	2010	21/21	46.1/51.5	9/12	6/15	0.4 mg tamsulosin for 4 weeks/control	4 weeks	6F/−	PI 2 weeks and 4 weeks
Shelbaia and Elnashar^Citation17	2011	69/67	35.0/29.0	44/25	50/17	0.4 mg tamsulosin for 4 weeks/control	4 weeks	6F/26	–
Mokhtari et al^Citation18	2011	33/33	–	–	–	2 mg terazosin for 4 weeks/control	4 weeks	4.8F/−	PI 4 weeks
Kuyumcuoglu et al^Citation19	2012	21/21	45.2/42.9	15/6	7/14	4 mg doksazosin for 4 weeks/control	–	4.7F/26–28	PI 4 weeks
Nazim and Ather^Citation20	2012	65/65	37.8/40.1	52/13	49/16	10 mg alfuzosin for 1 week/placebo	>1 week	4.7–6F/−	PI 1 week
Shalaby et al^Citation21	2013	82/81	41.3/44	55/27	50/31	0.4 mg tamsulosin for 2 weeks/control	–	–	PI 2 weeks
Tehranchi et al^Citation22	2013	23/24	38.4/33.4	16/7	21/3	2 mg terazosin for 13.5 days/placebo	13.5/15.4 days	4.8F/28	PI 2 weeks
Singh et al^Citation23	2014	30/30	32.7/31.4	14/16	20/10	0.4 mg tamsulosin for 4 weeks/placebo	6 weeks	4–5F/24–26	PI 4 weeks
Dellis et al^Citation24	2014	50/50	45.6/46.9	25/25	26/24	0.4 mg tamsulosin for 4 weeks/placebo	4 weeks	6F/24–26	PI 1 and 4 weeks, and PR 4 weeks
Dellis et al^Citation24	2014	50/50	47.3/46.9	23/27	26/24	10 mg alfuzosin for 4 weeks/placebo
Park et al^Citation25	2015	20/23	54.5/48.7	9/11	14/9	0.2 mg tamsulosin for 2 weeks/control	2 weeks	6F/20–28	PI 2 weeks, and PR 4 weeks
El-Nahas et al^Citation26	2015	40/40	41.4/40.8	19/21	24/16	0.4 mg tamsulosin for 5 weeks/placebo	5.1/4.8 weeks	6F/24–26	PI 1–2 weeks

Notes: Prulifloxacin 600 mg once daily for 5 days;¹² ciprofloxacin 500 mg twice daily for 5 days;¹⁷ patients in α-blocker groups were administered an additional week of antibiotic therapy;¹⁹ ciprofloxacin 500 mg twice daily for 5 days;²³ and 1 week of oral antibiotics (one tablet quinolone two times).²⁵

Abbreviations: RCT, randomized controlled trial; T, treatment group; C, control group; y, years; PI, post-insertion of stent; PR, post-removal of stent.

Figure 1 PRISMA flow diagram.

Abbreviations: RCT, randomized controlled trial; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 2 Methodological assessment.

Figure 3 Meta-analysis results of mean urinary symptom score.

Abbreviations: 95% CI, 95% confidence interval; df, degrees of freedom.

Figure 4 Meta-analysis results of mean pain index score.

Abbreviations: 95% CI, 95% confidence interval; df, degrees of freedom.

Figure 5 Meta-analysis results of mean general health index score.

Abbreviations: 95% CI, 95% confidence interval; df, degrees of freedom.

Table 2 Sensitivity analysis and indirect-comparison meta-analysis results

	Urinary symptom score		Pain index score		General health index score		Sexual matters score
	I^2	MD (95% CI)	I^2	MD (95% CI)	I^2	MD (95% CI)	I^2	MD (95% CI)
Sensitivity analysis
High-quality study	52%	−3.87 (−4.47, −3.28)	0%	−2.71 (−3.00, −2.42)	76%	−1.25 (−1.73, −0.77)	75%	−0.36 (−0.64, −0.09)
Age ≤50 y	36%	−3.77 (−4.27, −3.27)	0%	−2.69 (−3.06, −2.32)	0%	−1.05 (−1.24, −0.86)	79%	−0.35 (−0.72, 0.01)*
>50 y	94%	−5.35 (−11.01, 0.31)*	0%	−1.85 (−2.18, −1.51)	86%	−1.67 (−3.62, 0.28)*	0%	−0.55 (−0.75, −0.34)
Stent <6F	54%	−4.92 (−7.29, −2.54)	0%	−2.74 (−3.03, −2.44)	83%	−1.70 (−3.75, 0.34)*	0%	−0.59 (−0.82, −0.37)
≥6F	95%	−4.15 (−5.79, −2.50)	99%	−0.08 (−0.31, 0.15)*	96%	−0.29 (−0.45, −0.14)	75%	−0.33 (−0.65, −0.02)
Tamsulosin	95%	−4.32 (−6.83, −1.82)	99%	−0.52 (−0.78, −0.27)	95%	−0.14 (−0.29, 0.01)*	81%	−0.41 (−0.91, 0.09)*
Other α−blockers#	58%	−3.94 (−4.98, −2.90)	20%	−2.66 (−3.35, −1.97)	89%	−1.48 (−2.62, −0.34)	18%	−0.47 (−0.66, −0.29)
Indirect comparison
Tamsulosin vs other α-blockers		−0.38 (−3.09, 2.33)*		2.14 (1.41, 2.88)		1.34 (0.19, 2.49)		0.06 (−0.39, 0.51)*

Notes:

* No significant difference was found.

# Other α-blockers included alfuzosin and terazosin.

Abbreviations: y, years; MD, mean difference; CI, confidence interval.

Figure 6 Meta-analysis results of sexual matters score.

Abbreviations: 95% CI, 95% confidence interval; df, degrees of freedom.

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