The Efficacy Of Tamsulosin Combined With Scopolamine Bubromine Assisted ESWL In The Treatment Of Upper Urinary Calculi: A Meta-analysis

Objective:This study conducted a meta-analysis to systematically evaluate the efficacy of Tamsulosin combined with scopolamine bubromine assisted ESWL in the treatment of upper urinary calculi,in order to provide evidence-based guidance for the clinical application of Tamsulosin combined with scopolamine bubromine assisted ESWL in the treatment of upper urinary calculi.Methods:According to the purpose of the research,the search term and search mode were formulated,and the search strategy was determined.Pub Med,Web of science,The Cochrane Library,Embase,CNKI,Wanfang database,VIP database and Chinese Medical biology literature database were searched by computer.randomized controlled trials about Tamsulosin plus scopolamine bromide in ESWL for patients with upper urinary calculi were collected,and the included references were searched,with a time limit of December2022.According to the inclusion and exclusion criteria,the final documents were selected independently,and the data extraction and quality evaluation were carried out for the final included documents.Meta-analysis was performed on the extracted literature data using Review Manager5.3 software.The main outcome indicators were: effective rate,stone depletion time,disappearance time of renal colic,pain score,inflammatory factors(IL-6,CRP,TNF-α,PCT),and adverse reactions.The results were shown in the forest map.Results:Finally,a total of 10 literatures were included,including a total of 1950 patients,including 981 patients in the experimental group and 969 patients in the control group.Metaanalysis of 6 outcome indicators showed that:(1)Treatment response rate: RR=1.21,95%CI:1.16-1.26,Z=8.44,P < 0.00001;(2)Stone removal time: SMD=-2.76,95%CI=-3.37 ～-2.15,Z=8.87,P < 0.00001;(3)The disappearance time of renal colic was SMD=-2.08,95%CI=-2.21--1.95,Z=31.02,P < 0.00001;(4)Pain score: NPRS group SMD=-2.11,95%CI=-2.46 ～-1.75,Z=11.55,P < 0.00001;VAS group SMD=-1.73,95%CI=-2.69 ～-0.78,Z=3.58,P=0.0003;After the combination,SMD=-1.82,95%CI=-2.61 ～-1.03,Z=4.51,P < 0.00001;(5)Inflammatory factors: TNF-α : MD=-8.20,95%CI=-9.30 ～-7.09,Z=14.48,P < 0.00001,;CRP: MD=-7.18,95%CI=-7.57 ～-6.80,Z=36.40,P <0.00001;IL-6: MD=-5.03,95%CI=-5.80 ～-4.26,Z=12.84,P < 0.00001;PCT: MD=-0.31,95%CI=-0.33 ～-0.28,Z=27.65,P < 0.00001,the above differences were statistically significant.(6)Adverse reactions: RR=0.89,95%CI= 0.53-1.50,Z=0.43,P=0.67,the difference was not statistically significant.Conclusion:For patients with upper urinary tract calculi,Tamsulosin combined with scopolamine bubromide-assisted ESWL therapy has more advantages than scopolamine bubromideassisted ESWL therapy in improving treatment efficiency,promoting stone removal,shortening pain duration,reducing pain degree of postoperative renal colic and improving inflammation(IL-6,CRP,TNF-α,PCT).However,there are some limitations in this study.It is expected that there will be more high-quality RCTS with multi-center and large samples in the future to provide evidence-based medicine evidence for clinical drug guidance.