The low risk of publication bias in the outcomes of expulsion rate and complications is shown by the shapes of the inverted funnel plots (Fig. 4).
The management of ureteral stones has largely evolved from open surgery to minimally invasive methods, such as extracorporeal shockwave lithotripsy (ESWL), ureterorenoscopic removal of stones, or watchful waiting, due to the many advances in endourological techniques and instrumentation. The management of ureteral stones with open surgery has evolved to the use of minimally invasive methods due to advances in endourological techniques and instrumentation. Currently, the most widely accepted therapies for ureteral colic are minimally invasive and are the gold standard treatments. However, these techniques are quite expensive, even though they are associated with decreased risk, and are not widely available in developing countries. A treatment that can aid in the passage of urinary stones without surgery could reduce both patient morbidity and healthcare costs associated with this condition. Watchful waiting and medical expulsion therapy are the 2 most commonly used conservative methods that have been increasingly more frequently used in the treatment of distal ureteral stones to allow spontaneous stone passage, especially in patients who have less than grade 2 hydronephrosis. Prior published meta-analyses, as well as the current American Urological Association Guidelines on the Surgical Management of Colic, provide a strong recommendation that tamsulosin be used in these patients. In addition, other types of α-adrenoceptor antagonists, such as nifedipine, have also been suggested to have efficacy in some studies; at the time of the trial design, a trial by Pickard et al showed that the duration of use of agents including nifedipine could increase the rate of spontaneous stone passage and relieve pain. However, tamsulosin remains the most commonly used pharmaceutical.
There are some limitations in this study. First, the control methods used in the included studies were different; some used a placebo, some used watchful waiting, and some used massive intake of water; second, we did not compare tamsulosin with other α-blockers or medicines. Most of the studies focused on stone expulsion, and few explored pain relief, even though this symptom is the most important reason why patients present to emergency clinics. The exploration of pain relief requires further study.
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