Efficacy and safety of doxazosin for ureterolithiasis: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Fan ,  YANG Lu ,  WEI Qiang

Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding?author：

YANG Lu, Email: wycleflue@163.com; WEI Qiang, Email: weiqiang933@126.com

Keywords：

Ureterolithiasis; Doxazosin; Tamsulosin; Efficacy; Safety; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.201812104

Video：

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Objectives To systematically review the efficacy and safety of doxazosin for ureterolithiasis.Methods PubMed, EMbase, Web of Science, The Cochrane Library and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of comparing doxazosin with conservative treatment or tamsulosin for ureterolithiasis from inception to October, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, RevMan 5.3 software was used to perform meta-analysis.Results A total of 15 RCTs involving 1 062 patients were included. The results of meta-analysis showed that: compared with conservative treatment, doxazosin significantly facilitated ureteral stone expulsion (RR=1.62, 95%CI 1.45 to 1.81, P<0.000 01). No statistical significant difference was found in stone-free rate (RR=0.96, 95%CI 0.83 to 1.11, P=0.57), stone expulsion time (SMD=?0.17, 95%CI ?0.52 to 0.19, P=0.35) or pain episode frequency (SMD=0.21, 95%CI ?0.15 to 0.56, P=0.25) between doxazosin and tamsulosin. Treatment-associated serious side effects were rarely reported.Conclusion Current evidence shows that doxazosin is an efficient and safe medical expulsion agent for ureterolithiasis management. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

Citation： WANG Fan, YANG Lu, WEI Qiang. Efficacy and safety of doxazosin for ureterolithiasis: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(7): 828-835. doi: 10.7507/1672-2531.201812104 Copy

1.	那彥群. 中國泌尿外科疾病診斷治療指南. 北京: 人民衛生出版社, 2011.
2.	Türk C, Knoll T, Seitz C, et al. Medical expulsive therapy for ureterolithiasis: the EAU recommendations in 2016. Eur Urol, 2017, 71(4): 504-507.
3.	Wang RC, Smith-Bindman R, Whitaker E, et al. Effect of tamsulosin on stone passage for ureteral stones: a systematic review and meta-analysis. Ann Emerg Med, 2017, 69(3): 353-361.
4.	Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions. Available at: http://handbook.cochrane.org.
5.	Yilmaz E, Batislam E, Basar MM, et al. The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones. J Urol, 2005, 173(6): 2010-2012.
6.	Sen H, Erturhan S, Sadioglu E, et al. A comparison of efficacy of doxazosin 4 and 8 mg in medical expulsive therapy of distal ureteral stones: a prospective randomized clinical trial. Urolithiasis, 2017, 45(5): 461-464.
7.	Liatsikos EN, Katsakiori PF, Assimakopoulos K, et al. Doxazosin for the management of distal-ureteral stones. J Endourol, 2007, 21(5): 538-541.
8.	Aydogdu O, Burgu B, Gucuk A, et al. Effectiveness of doxazosin in treatment of distal ureteral stones in children. J Urol, 2009, 182(6): 2880-2884.
9.	Ayubov B, Arustamov D, Mukhtarov S. Efficacy of doxazosin in the management of ureteral stones. Eur Urol Suppl, 2007, 6(2): 114-114.
10.	Erturhan S, Bayrak O, Sarica K, et al. Efficacy of medical expulsive treatment with doxazosin in pediatric patients. Urology, 2013, 81(3): 640-643.
11.	Hassan Ali M, Elatrash G, Hafez H, et al. MP-03.14: Comparative study on the efficacy of different alpha adrenergic blockers for distal ureteral stones with or without shock wave lithotripsy. Urology, 2007, 70(3): 56.
12.	Zehri AA, Ather MH, Abbas F, et al. Preliminary study of efficacy of doxazosin as a medical expulsive therapy of distal ureteric stones in a randomized clinical trial. Urology, 2010, 75(6): 1285-1288.
13.	Mukhtarov S, Turdev A, Fozilov A, et al. Using doxazosin for distal ureteral stone clearance with or without shock wave lithotripsy. Eur Urol Suppl, 2007, 6(2): 216.
14.	Jafri SSA, Chughtai MN. The effectiveness and comparison of three different alfha-1 adrenergic blockers for the medical management of distal ureteral stones. J Allama Iqbal Med Coll, 2009, 7(3): 6-11.
15.	Khawaja AA, Ahmed R, Anjum R, et al. Role of alpha blockers in the management of lower ureteric stones. MFM, 2005, 16(1): 7-11.
16.	Ben RS, Sallami S, Mohamed C, et al. Comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones. Urology, 2009, 74(4): S341.
17.	Mshemish BAR. A comparative study between tamsulosin and doxazosin for management of lower ureteral stones. Iraqi J Comm Med, 2012, 25(2): 153-157.
18.	李茂春, 胡衛鋒. 多沙唑嗪治療輸尿管下段結石的療效觀察. 中國藥師, 2011, 14(11): 1639-1640.
19.	魏本林, 倪梁朝, 陶令之, 等. 多沙唑嗪治療輸尿管中下段結石療效分析. 白求恩軍醫學院學報, 2011, 9(3): 189-190.
20.	羅德惠, 萬翔, 劉際明, 等. 如何實現從樣本量、中位數、極值或四分位數到均數與標準差的轉換. 中國循證醫學雜志, 2017, 17(11): 1350-1356.
21.	Hollingsworth JM, Canales BK, Rogers MA, et al. Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis. BMJ, 2016, 355: i6112.
22.	Liu C, Zeng G, Kang R, et al. Efficacy and safety of alfuzosin as medical expulsive therapy for ureteral stones: a systematic review and meta-analysis. PLoS One, 2015, 10(8): e0134589.
23.	Huang W, Xue P, Zong H, et al. Efficacy and safety of silodosin in the medical expulsion therapy for distal ureteral calculi: a systematic review and meta-analysis. Br J Clin Pharmacol, 2016, 81(1): 13-22.
24.	Campschroer T, Zhu X, Vernooij RWM, et al. A-blockers as medical expulsive therapy for ureteric stones: a cochrane systematic review. BJU Int, 2018, 122(6): 932-945.
25.	Alevizopoulos A, Zosimas D, Piha L, et al. Managing small ureteral stones: a retrospective study on follow-up, clinical outcomes and cost-effectiveness of conservative management vs. early surgery. Curr Urol, 2016, 9(1): 36-43.
26.	Hollingsworth JM, Norton EC, Kaufman SR, et al. Medical expulsive therapy versus early endoscopic stone removal for acute renal colic: an instrumental variable analysis. J Urol, 2013, 190(3): 882-887.
27.	Bensalah K, Pearle M, Lotan Y. Cost-effectiveness of medical expulsive therapy using alpha-blockers for the treatment of distal ureteral stones. Eur Urol, 2008, 53(2): 411-418.
28.	Vermandere M, Kuijpers T, Burgers J S, et al. Alpha-blockers for uncomplicated ureteral stones: a clinical practice guideline. BJU Int, 2018, 122(6): 1457-1462.
29.	Miller OF, Kane CJ. Time to stone passage for observed ureteral calculi: a guide for patient education. J Urol, 1999, 162(3 Pt 1): 688-690.
30.	Tian D, Li N, Huang W, et al. The efficacy and safety of adrenergic alpha-antagonists in treatment of distal ureteral stones in pediatric patients: A systematic review and meta-analysis. J Pediatr Surg, 2017, 52(2): 360-365.
31.	Eryildirim B, Sahin C, Tuncer M, et al. Effect of medical expulsive therapy on the health-related quality of life of patients with ureteral stones: a critical evaluation. Int Urol Nephrol, 2015, 47(8): 1271-1275.
32.	Bell JR, Penniston KL, Best SL, et al. A survey of patient preferences regarding medical expulsive therapy following the SUSPEND trial. Can J Urol, 2017, 24(3): 8827-8831.

1. 那彥群. 中國泌尿外科疾病診斷治療指南. 北京: 人民衛生出版社, 2011.
2. Türk C, Knoll T, Seitz C, et al. Medical expulsive therapy for ureterolithiasis: the EAU recommendations in 2016. Eur Urol, 2017, 71(4): 504-507.
3. Wang RC, Smith-Bindman R, Whitaker E, et al. Effect of tamsulosin on stone passage for ureteral stones: a systematic review and meta-analysis. Ann Emerg Med, 2017, 69(3): 353-361.
4. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions. Available at: http://handbook.cochrane.org.
5. Yilmaz E, Batislam E, Basar MM, et al. The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones. J Urol, 2005, 173(6): 2010-2012.
6. Sen H, Erturhan S, Sadioglu E, et al. A comparison of efficacy of doxazosin 4 and 8 mg in medical expulsive therapy of distal ureteral stones: a prospective randomized clinical trial. Urolithiasis, 2017, 45(5): 461-464.
7. Liatsikos EN, Katsakiori PF, Assimakopoulos K, et al. Doxazosin for the management of distal-ureteral stones. J Endourol, 2007, 21(5): 538-541.
8. Aydogdu O, Burgu B, Gucuk A, et al. Effectiveness of doxazosin in treatment of distal ureteral stones in children. J Urol, 2009, 182(6): 2880-2884.
9. Ayubov B, Arustamov D, Mukhtarov S. Efficacy of doxazosin in the management of ureteral stones. Eur Urol Suppl, 2007, 6(2): 114-114.
10. Erturhan S, Bayrak O, Sarica K, et al. Efficacy of medical expulsive treatment with doxazosin in pediatric patients. Urology, 2013, 81(3): 640-643.
11. Hassan Ali M, Elatrash G, Hafez H, et al. MP-03.14: Comparative study on the efficacy of different alpha adrenergic blockers for distal ureteral stones with or without shock wave lithotripsy. Urology, 2007, 70(3): 56.
12. Zehri AA, Ather MH, Abbas F, et al. Preliminary study of efficacy of doxazosin as a medical expulsive therapy of distal ureteric stones in a randomized clinical trial. Urology, 2010, 75(6): 1285-1288.
13. Mukhtarov S, Turdev A, Fozilov A, et al. Using doxazosin for distal ureteral stone clearance with or without shock wave lithotripsy. Eur Urol Suppl, 2007, 6(2): 216.
14. Jafri SSA, Chughtai MN. The effectiveness and comparison of three different alfha-1 adrenergic blockers for the medical management of distal ureteral stones. J Allama Iqbal Med Coll, 2009, 7(3): 6-11.
15. Khawaja AA, Ahmed R, Anjum R, et al. Role of alpha blockers in the management of lower ureteric stones. MFM, 2005, 16(1): 7-11.
16. Ben RS, Sallami S, Mohamed C, et al. Comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones. Urology, 2009, 74(4): S341.
17. Mshemish BAR. A comparative study between tamsulosin and doxazosin for management of lower ureteral stones. Iraqi J Comm Med, 2012, 25(2): 153-157.
18. 李茂春, 胡衛鋒. 多沙唑嗪治療輸尿管下段結石的療效觀察. 中國藥師, 2011, 14(11): 1639-1640.
19. 魏本林, 倪梁朝, 陶令之, 等. 多沙唑嗪治療輸尿管中下段結石療效分析. 白求恩軍醫學院學報, 2011, 9(3): 189-190.
20. 羅德惠, 萬翔, 劉際明, 等. 如何實現從樣本量、中位數、極值或四分位數到均數與標準差的轉換. 中國循證醫學雜志, 2017, 17(11): 1350-1356.
21. Hollingsworth JM, Canales BK, Rogers MA, et al. Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis. BMJ, 2016, 355: i6112.
22. Liu C, Zeng G, Kang R, et al. Efficacy and safety of alfuzosin as medical expulsive therapy for ureteral stones: a systematic review and meta-analysis. PLoS One, 2015, 10(8): e0134589.
23. Huang W, Xue P, Zong H, et al. Efficacy and safety of silodosin in the medical expulsion therapy for distal ureteral calculi: a systematic review and meta-analysis. Br J Clin Pharmacol, 2016, 81(1): 13-22.
24. Campschroer T, Zhu X, Vernooij RWM, et al. A-blockers as medical expulsive therapy for ureteric stones: a cochrane systematic review. BJU Int, 2018, 122(6): 932-945.
25. Alevizopoulos A, Zosimas D, Piha L, et al. Managing small ureteral stones: a retrospective study on follow-up, clinical outcomes and cost-effectiveness of conservative management vs. early surgery. Curr Urol, 2016, 9(1): 36-43.
26. Hollingsworth JM, Norton EC, Kaufman SR, et al. Medical expulsive therapy versus early endoscopic stone removal for acute renal colic: an instrumental variable analysis. J Urol, 2013, 190(3): 882-887.
27. Bensalah K, Pearle M, Lotan Y. Cost-effectiveness of medical expulsive therapy using alpha-blockers for the treatment of distal ureteral stones. Eur Urol, 2008, 53(2): 411-418.
28. Vermandere M, Kuijpers T, Burgers J S, et al. Alpha-blockers for uncomplicated ureteral stones: a clinical practice guideline. BJU Int, 2018, 122(6): 1457-1462.
29. Miller OF, Kane CJ. Time to stone passage for observed ureteral calculi: a guide for patient education. J Urol, 1999, 162(3 Pt 1): 688-690.
30. Tian D, Li N, Huang W, et al. The efficacy and safety of adrenergic alpha-antagonists in treatment of distal ureteral stones in pediatric patients: A systematic review and meta-analysis. J Pediatr Surg, 2017, 52(2): 360-365.
31. Eryildirim B, Sahin C, Tuncer M, et al. Effect of medical expulsive therapy on the health-related quality of life of patients with ureteral stones: a critical evaluation. Int Urol Nephrol, 2015, 47(8): 1271-1275.
32. Bell JR, Penniston KL, Best SL, et al. A survey of patient preferences regarding medical expulsive therapy following the SUSPEND trial. Can J Urol, 2017, 24(3): 8827-8831.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of doxazosin for ureterolithiasis: a meta-analysis

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