目的:我们对托特罗定和α-肾上腺素能受体阻滞剂缓解输尿管支架相关症状的疗效和并发症进行了系统评价。
方法:直到2023年8月,我们对PubMed进行了全面的文献检索,Embase,WebofScience,和Cochrane图书馆确定随机对照试验,评估托特罗定和α-肾上腺素能受体阻滞剂治疗输尿管支架相关症状的疗效和并发症。两名评审员独立筛选研究并提取数据。总结并比较了输尿管支架症状问卷(USSQ)各个领域的得分,采用RevMan5.4.0软件进行统计学分析。
结果:共有8项研究符合我们分析的纳入标准。这些研究是在不同的中心进行的。所有研究均为随机对照试验,共涉及487名患者,244例接受α-肾上腺素能受体阻滞剂的患者和243例接受托特罗定的患者。结果表明,托特罗定在身体疼痛方面表现出显着更好的改善(MD,1.56;95%CI[0.46,2.66];p=0.005)(MD,0.46;95%CI[0.12,0.80];p=0.008)(MD,3.21;95%CI[1.89,4.52];p=0.00001)在不同时间点输尿管支架置入后的患者与α-肾上腺素能受体阻滞剂相比。此外,在4周,托特罗定在一般健康状况方面表现出优异的改善(MD,0.15;95%CI[0.03,0.27];p=0.01)和泌尿症状(MD,1.62;95%CI[0.59,2.66];p=0.002)与α-肾上腺素能受体阻滞剂相比,在6周的时候,托特罗定在工作绩效方面表现出更好的改善(MD,-1.60;与α-肾上腺素能受体阻滞剂相比,95%CI[-2.73,-0.48];p=0.005)。此外,口干的发生率(RR,4.21;95%CI[1.38,12.87];p=0.01)与α-肾上腺素能受体阻滞剂相比,使用托特罗定较高。然而,两种药物在其他结局方面无显著统计学差异.
结论:这项荟萃分析表明,托特罗定在改善输尿管支架置入后的身体疼痛症状方面优于α-肾上腺素能受体阻滞剂,而α-肾上腺素能受体阻滞剂在提高工作表现方面比托特罗定更有效。此外,与α-肾上腺素能受体阻滞剂相比,使用托特罗定的口干发生率更高。然而,需要更高质量的随机对照试验来进一步研究这一问题.
OBJECTIVE: We conducted a systematic evaluation of the therapeutic efficacy and complications of tolterodine and α-adrenergic receptor blockers in alleviating ureteral stent-related symptoms.
METHODS: Until August 2023, we conducted a comprehensive literature search on PubMed, Embase, Web of Science, and Cochrane Library to identify randomized controlled trials evaluating the efficacy and complications of tolterodine and α-adrenergic receptor blockers in treating ureteral stent-related symptoms. Two reviewers independently screened studies and extracted data. The scores from various domains of the Ureteral Stent Symptom Questionnaire (USSQ) were summarized and compared, and statistical analysis was performed using RevMan 5.4.0 software.
RESULTS: A total of 8 studies met the inclusion criteria for our analysis. These studies were conducted at different centers. All studies were randomized controlled trials, involving a total of 487 patients, with 244 patients receiving α-adrenergic receptor blockers and 243 patients receiving tolterodine. The results showed that tolterodine demonstrated significantly better improvement in body pain (MD, 1.56; 95% CI [0.46, 2.66]; p = 0.005) (MD, 0.46; 95% CI [0.12, 0.80]; p = 0.008) (MD, 3.21; 95% CI [1.89, 4.52]; p = 0.00001) among patients after ureteral stent placement compared to α-adrenergic receptor blockers at different time points. Additionally, at 4 weeks, tolterodine showed superior improvement in general health (MD, 0.15; 95% CI [0.03, 0.27]; p = 0.01) and urinary symptoms (MD, 1.62; 95% CI [0.59, 2.66]; p = 0.002) compared to α-adrenergic receptor blockers, while at 6 weeks, tolterodine showed better improvement in work performance (MD, -1.60; 95% CI [-2.73, -0.48]; p = 0.005) compared to α-adrenergic receptor blockers. Additionally, the incidence of dry mouth (RR, 4.21; 95% CI [1.38, 12.87]; p = 0.01) is higher with the use of tolterodine compared to α-adrenergic receptor blockers. However, there were no significant statistical differences between the two drugs in other outcomes.
CONCLUSIONS: This meta-analysis suggests that tolterodine is superior to α-adrenergic receptor blockers in improving physical pain symptoms after ureteral stent placement, while α-adrenergic receptor blockers are more effective than tolterodine in enhancing work performance. Additionally, the incidence of dry mouth is higher with the use of tolterodine compared to α-adrenergic receptor blockers. However, higher-quality randomized controlled trials are needed to further investigate this issue.