Investig Clin Urol.  2017 Mar;58(2):82-89. 10.4111/icu.2017.58.2.82.

Efficacy of phosphodiesterase type 5 inhibitors for the treatment of distal ureteral calculi: A systematic review and meta-analysis

• Montes Cardona CE
• García-Perdomo HA

• KMID: 2368472
• DOI: http://doi.org/10.4111/icu.2017.58.2.82

Abstract

PURPOSE
To determine the efficacy of phosphodiesterase type 5 inhibitors (PDE5i) as medical expulsive therapy (MET) for the treatment of distal ureteral calculi.
MATERIALS AND METHODS
A search strategy was conducted in the MEDLINE, CENTRAL, and Embase databases. Searches were also conducted in other databases and unpublished literature. Clinical trials were included without language restrictions. The risk of bias was evaluated with the Cochrane Collaboration's tool. An analysis of random effects due to statistical heterogeneity was conducted. The primary outcome was the expulsion rate of the distal ureteral calculus in 28 days. The secondary outcomes were the time to expulsion, side effects of treatment, and amount (mg) of nonopioid analgesia. The measure of the effect was the risk difference (RD) with a 95% confidence interval (CI). The planned interventions were PDE5i vs. placebo, tadalafil vs. placebo, and tadalafil vs. tamsulosin.
RESULTS
Four articles were included in the qualitative and quantitative analysis. Records of 580 patients were found among the four studies. A low risk of bias was shown for the majority of the study items. The calculi expulsion rate had an RD of 0.26 (95% CI, 0.15-0.37) and a less prolonged expulsion as a secondary outcome with a mean difference of -4.39 days (95% CI, -6.69 to -2.09) in favor of PDE5i compared with the placebo. No significant difference was found for these outcomes when comparing tadalafil with tamsulosin.
CONCLUSIONS
Compared with a placebo, PDE5i could be effective as MET for the treatment of distal ureter calculi.

Keyword

Meta-analysis; Phosphodiesterase 5 inhibitors; Review; Ureteral calculi

MeSH Terms

Analgesia
Bias (Epidemiology)
Calculi
Humans
Phosphodiesterase 5 Inhibitors*
Population Characteristics
Tadalafil
Ureter*
Ureteral Calculi*
Phosphodiesterase 5 Inhibitors
Tadalafil

Figure

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  Fig. 1 Flowchart. RCT, randomized clinical trial.

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  Fig. 2 Risk of bias. (A) Within studies. (B) Among studies.

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  Fig. 3 (A) Phosphodiesterase type 5 inhibitors (PDE5i) versus placebo: calculus expulsion rate. (B) PDE5i versus placebo: time to expulsion. df, degrees of freedom; CI, confidence interval.

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  Fig. 4 Tadalafil versus tamsulosin: calculus expulsion rate. df, degrees of freedom; CI, confidence interval.

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