Terpene compound drug as medical expulsive therapy for ureterolithiasis: a meta-analysis.

The aim of this study is to investigate the efficacy of terpene compound drug (pinene, camphene, borneol, anethole, fenchone and cineol in olive oil) in facilitating spontaneous passage of ureteral calculi through meta-analysis of randomized controlled trials (RCT). Systematic literature search on MEDLINE, EMBASE, OVID, Science Direct, Proquest, Google scholar, Cochrane Library databases and reference list of related literatures were done without language restriction. RCTs on ureterolithiasis medical expulsive therapy (MET) that compare terpene compound drug versus placebo/control group or alpha-blockers were identified. Articles retrieved were critically appraised by two independent reviewers according to Cochrane Collaboration recommendations. Data from included studies were extracted for calculation of risk ratio (RR) and 95 % confidence interval (CI). Effect estimates were pooled using Mantel-Haenszel method with random effect model. Inter-study heterogeneity and publication bias were assessed. The PRISMA guidelines for meta-analysis reporting were followed. Five RCTs (total of 344 subjects) of adequate methodological quality were included. Pooled effect estimates from homogenous studies showed that compared to placebo/control group, patients treated with terpene compound drug had significantly better ureteral calculi spontaneous expulsion rate (pooled RR: 1.34; 95 % CI 1.12, 1.61). Subgroup analysis of studies that compare terpene compound drug with alpha-blockers showed no significant difference (pooled RR: 0.79; 95 % CI 0.59, 1.06), while significant inter-study heterogeneity was noted. Only minor gastrointestinal adverse effect was reported on terpene compound drug use. The results suggest that terpene compound drug as MET is effective in augmenting spontaneous passage of ureterolithiasis. High quality large-scale RCTs comparing alpha-blockers and terpene compound drug are warranted to make a more definitive conclusion.