Comparative efficacy of tamsulosin versus nifedipine for distal ureteral calculi: a meta-analysis

Figures & data

Table 1 Characteristics of the included RCTs

Study	Case (T/C)	Age (T/C, years)	Sex (M/F)		Intervention (T/C)	Size (T/C, mm)	Follow-up	Others
			T	C
Porpiglia et al^Citation11	28/30	NR	NR		TA/nifedipine 30 mg	5.42/4.7	4 weeks	Deflazacort 30 mg for all patients
Dellabella et al^Citation12	70/70	43.8±13.9/41.8±15.4	54/16	51/19	TA/nifedipine 30 mg	7.2±2.4/6.2±1.5	4 weeks	Antibiotic prophylaxis or anti-inflammatory drugs on demand
Lü et al^Citation13	60/60	38±13/34±13	51/9	42/18	TA/nifedipine 30 mg	7.0±2.0/7.0±2.0	2 weeks	Levofloxacin 0.2 g and 2 L of water daily
Choi et al^Citation14	32/31	47.9±14.2/45.2±11.1	25/7	26/5	TA 0.2 mg/nifedipine	7.6±1.5/7.3±1.3	2 weeks	Patients underwent ESWL
Vicentini et al^Citation15	38/35	47.3±11.5/48.6±10.4	16/22	18/17	TA/nifedipine 20 mg	10 (5–20)/10 (5–20)	4 weeks	Patients underwent ESWL and 200 mg celecoxib, twice daily on demand
Ye et al^Citation16	1,596/1,593	30.7 (18–48)/34.5 (22–50)	998/598	989/604	TA/Nifedipine 30 mg	5.8 (4.0–7.0)/5.6 (4.2–6.9)	4 weeks	Levofloxacin 0.2 g and 2–2.5 L of water daily
Liao et al^Citation17	59/53	34 (19–49)	58/54		TA/nifedipine 20 mg	6.2±1.2/5.8±1.3	4 weeks	Quinolone antibiotics used and >2 L of water daily
Islam et al^Citation18	32/31	46.6/47.4	20/12	21/10	TA/nifedipine 20 mg	5.9 (3–10)/6.0 (3.5–10)	4 weeks	Ciprofloxacin 500 mg, twice a day, and 2.5 L of hydration daily
Gandhi and Agrawal^Citation19	64/64	34±12.8/30.4±11.36	38/26	36/28	TA/nifedipine 30 mg	8.6±2.3/8.9±2.5	4 weeks	Prednisolone 30 mg/d for 10 days and diclofenac 75 mg intramuscularly on demand
Balci et al^Citation20	25/25	39.5±12.1/36.4±11.5	18/7	17/8	TA/nifedipine 30 mg	7.1±1.5/6.4±1.1	4 weeks	50 mg diclofenac sodium and 2–2.5 L of water daily
Pickard et al^Citation21	383/383	43.1±11.5/42.3±11.0	315/68	317/66	TA/nifedipine 30 mg	4.6±1.6/4.5±1.6	4 weeks	The need for intervention was agreed
Zhang et al^Citation22	102/97	34.6±11.4/36.3±9.7	63/29	68/29	TA/nifedipine 30 mg	6.9±1.6/6.8±1.6	4 weeks	75 mg diclofenac sodium and analgesic therapy on demand

Notes: Data were presented as median (range) or mean ± standard deviation. Location was distal mean/stones located in juxtavesical or intramural tract. (T) and (C) represent the treatment and control group, respectively.

Abbreviations: ESWL, extracorporeal shock wave lithotripsy; F, female; M, male; NR, not reported; RCTs, randomized controlled trial; TA, tamsulosin 0.4 mg/d.

Figure 1 Flowchart of literature selection process.

Figure 2 Quality assessment graph.

Note: (+) low risk, (?) unclear risk, (−) high risk.

Figure 3 Meta-analysis results of expulsion rate between the groups.

Abbreviations: df, degrees of freedom; M–H, Mantel Haenszel; CI, confidence interval.

Figure 4 Meta-analysis results of expulsion time between the groups.

Abbreviations: CI, confidence interval; df, degrees of freedom; SD, standard deviation; IV, inverse variance.

Table 2 Subgroup analysis according to diagnosis of complications

Diagnosis	Case (n/N)		I^2 (%)	Model	RR	P-value
	Tamsulosin	Nifedipine
Dizziness	24/127	13/124	80	Random effects	2.08 (0.32, 13.36)	0.44
Gastric upset	16/476	2/468	73	Random effects	1.64 (0.06, 47.99)	0.77
Diarrhea	0/476	17/468	0	Fixed effects	0.08 (0.02, 0.42)	0.003
Hypotension	0/91	2/84	0	Fixed effects	0.31 (0.03, 2.93)	0.31
Emergency	5/108	12/105	0	Fixed effects	0.41 (0.16, 1.05)	0.06
Headache	32/451	29/443	0	Fixed effects	1.10 (0.76, 1.59)	0.61
Fatigue	3/64	0/64	–	–	7.0 (0.37, 132.83)	0.20
Steinstrasse	5/38	4/35	–	–	1.15 (0.34, 3.95)	0.82

Abbreviation: RR, risk ratio.

Figure 5 Meta-analysis results of complications between the groups.

Abbreviations: CI, confidence interval; df, degrees of freedom; M–H, Mantel Haenszel.

Figure 6 Inverted funnel plot investigating publication bias.

Abbreviations: RR, risk ratio; SE, standard error.

PorpigliaFGhignoneGFioriCFontanaDScarpaRMNifedipine versus tamsulosin for the management of lower ureteral stonesJ Urol2004172256857115247732

 PubMed Web of Science ®Google Scholar

DellabellaMMilaneseGMuzzonigroGRandomized trial of the efficacy of tamsulosin, nifedipine and phloroglucinol in medical expulsive therapy for distal ureteral calculiJ Urol2005174116717215947613

 PubMed Web of Science ®Google Scholar

LüJJWeiLJZhangHComparison of tamsulosin versus nifedipine for the management of lower ureteral stonesChin J Urol2006279612614 in Chinese

 Google Scholar

ChoiNYAhnSHHanJHJangIHThe effect of tamsulosin and nifedipine on expulsion of ureteral stones after extracorporeal shock wave lithotripsyKorean J Urol2008492150154

 Google Scholar

VicentiniFCMazzucchiEBritoAHChedid NetoEADanilovicASrougiMAdjuvant tamsulosin or nifedipine after extracorporeal shock wave lithotripsy for renal stones: a double blind, randomized, placebo-controlled trialUrology20117851016102121802124

 PubMed Web of Science ®Google Scholar

YeZYangHLiHA multicentre, prospective, randomized trial: comparative efficacy of tamsulosin and nifedipine in medical expulsive therapy for distal ureteric stones with renal colicBJU Int2011108227627921083640

 PubMed Web of Science ®Google Scholar

LiaoZMWangCChenZYeZQComparison of therapeutic effect of tamsulosin and nifedipine in treatment of distal ureteral calculusMod J Integr Tradit Chin West Med201120910461050

 Google Scholar

IslamMSIslamMWHoodaMNAlamAChowdhuryGMShameemIAThe comparison and efficacy of nifedipine and tamsulosin for the management of lower ureteric stonesBangladesh J Urol201213159

 Google Scholar

GandhiHRAgrawalCThe efficacy of tamsulosin vs. nifedipine for the medical expulsive therapy of distal ureteric stones: a randomised clinical trialArab J Urol201311440541026558112

 PubMedGoogle Scholar

BalciMTuncelAAydinOTamsulosin versus nifedipine in medical expulsive therapy for distal ureteral stones and the predictive value of Hounsfield unit in stone expulsionRen Fail201436101541154425238492

 PubMed Web of Science ®Google Scholar

PickardRStarrKMaclennanGMedical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trialLancet2015386999134134925998582

 PubMed Web of Science ®Google Scholar

ZhangMYDingSTLüJJZhangHXiaQHComparison of tamsulosin with extracorporeal shock wave lithotripsy in treating distal ureteral stonesChin Med J2009122779880119493392

 PubMed Web of Science ®Google Scholar