Outcomes of alpha‐blockers as medical expulsive therapy following shockwave lithotripsy: a systematic review and meta‐analysis. (20th October 2022) - Brain, Eleanor
Abstract : Objectives: To determine stone‐free rate following shockwave lithotripsy (SWL) with/without alpha‐blockers as well as complication rates (individual and classified using the Clavien–Dindo system). Materials and Methods: We performed a systematic review of all randomized controlled trials that included more than 20 patients (age > 18 years) and examined the use of alpha‐blockers after SWL. Meta‐analysis was performed using 'metafor' in R. We report risk ratios (RRs) with 95% confidence intervals (95% CIs). The PROSPERO ID for the trial was: CRD42021248108. Results: We assessed 158 full‐text articles and included a total of 21 studies in our review. There were 1445 patients receiving alpha‐blockers and 1478 control patients. Those receiving alpha‐blockers were significantly more likely to be stone‐free (RR 1.12, 95% CI 1.07–1.16; P < 0.001). This effect was robust to 'trim‐and‐fill' adjustment. In those taking alpha‐blockers there was a significant reduction in Clavien III–V complications and, on trim‐and‐fill adjustment, a significant reduction in Clavien I–II complications. There were also significant reduction in rates of steinstrasse, pain and requirement for auxiliary procedures. There was no significant difference in retreatment rates. These effects were robust to trim‐and‐fill adjustment. Conclusions: There is a modest increase in stone‐free rates in those receiving alpha‐blockers following SWL, with a reciprocal modest risk reduction for steinstrasse, pain and auxiliary procedures. However, alpha‐blockers do not reduce the risk of requiring retreatment.