Systematic review and meta-analysis of the adjuvant role of Medical Expulsive Therapy (MET) in Shock Wave Lithotripsy (SWL) treatment of upper urinary stones

Introduction: Medical expulsion therapy (MET) has been introduced as a method enhancing the spontaneous passage of stones and reducing the stone expulsion time after extracorporeal shockwave lithotripsy (SWL). The aim of the current meta-analysis was to analyze the data of randomized studies on MET implemented following SWL for renal and ureteral stones. Materials and Methods: A systematic literature search of CENTRAL, WEB OF SCIENCE, PUBMED and SCOPUS was performed. The criteria applied for the selection of the included studies were: randomized, placebo or other comparator (i.e analgesics) controlled studies dealing with renal or ureteral stones treated with SWL and MET (including plant extracts) with a minimum follow-up of 14 days. Subgroup analyses were a priori planned to be performed depending on the: type of α-blocker (i.e tamsulosin, alfuzosin, terazosin, doxazosin, Urapidil), size and location of stones. All results were combined for meta-analysis with the Review Manager. Results: Pooled results demonstrated the efficacy of α-blockers, nifedipine, Rowatinex and Uriston in increasing stone clearance. In addition, the time to stone elimination, the intensity of pain, the formation of steinstrasse and the need for auxillary procedures were reduced mainly with α-blockers. Expulsion rate was not correlated with the type of α-blocker, the stone diameter and the stone location. Conclusions: Evidence suggests that MET can be suggested as an adjuvant treatment after SWL due to its expulsive efficacy, pain reduction and safety profile. However, due to the clinical heterogeneity among the included studies, conclusions drawn