Study characteristics
In this review a total of 50 RCT’s with 12382 patients were
included6,
11, 15,
19, 22,
25-68. Multiple treatments across these
studies were assessed for medical expulsion of lower ureteric stone
(alfuzosin (AL), alfuzosin plus steroids (AL-S), naftopidil (NAF),
naftopidil plus steroids (NAF-S), nifedipine (NIF), nifedipine plus
steroids (NIF-S), sildenafil (SIL), silodosin (SILO), tadalafil (TAD),
tamsulosin (TAM), tamsulosin plus steroids (TAM-S), tadalafi plus
silodosin, (TADplusSILO), tadalafil plus tamsulosin (TADplusTAM),
tadalafil plus tamsulosin plus steroids (TADplusTAM-S). Control group
was variably defined across the studies some including placebo (16
studies), others including best medical management with adequate
hydration, analgesics and anti-spasmodics. Control with no specific
treatment group was found in 9
studies26,
33, 45,
46, 53,
58, 59,
65, 69,
diclofenac was used as control in 5
studies6,
27,
47-49, study by
Cervanakov28 used tramadol with Veral and diazepam and
Sio et al used Aescin with diclofenac70. Duration of
treatment was variable across the studies ranging from 10 days to 6
weeks. All the groups compared well for baseline characteristics such as
age, sex and stone size. All the studies included patients with stone
size less than 10 mm. (Table 1)
Network map for the two outcomes i.e. stone expulsion rate (SER) and
stone expulsion time (SET) are provided in Figure 2. For SER mixed
evidence was available for 27 comparisons whereas indirect evidence was
available for 78 comparisons. Most common comparison studied for this
outcome was TAM versus C with 21 studies followed by NIF vs. TAM (6
studies), ALvs.C (5 studies), AL vs. TAM (4 studies). Tamsulosin was the
most commonly studied drug across the network for SER with
representation in 34 studies whereas
AL-S71,
TADplusTAM42,
TADplusTAM-S43,
TADplusSILO15 and
SIL11 were limited to
single studies. For secondary outcome i.e. SET, data was available from
32 studies with 13 treatment groups AL, NAF-S, NIF, NAF, NIF-S SIL,
SILO, TAD, TADplusSILO, TADplusTAM, TADplusTAM-S, TAM-S and TAM. Most
common comparison across the studies was C vs. TAM (13 studies),
followed by 3 comparisons for each AL vs. C, C vs. NAF, SILO vs. TAM and
TAM vs. TAD.