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Submitted: 23 February 2013 Modified: 10 March 2015
HERDIN Record #: PCHRD13022314094363

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

Michael E. Chua,
Jane H. Park,
Josefino C. Castillo,
Marcelino L. Morales Jr.

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OBJECTIVE: 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

METHODS: Systematic literature search of the MEDLINE, EMBASE, OVID, Science Direct, Proquest, Google scholar, Cochrane Library databases and rference lists of related literature was done without language restriction. Trials 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.

RESULTS: Five trials (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 higher ureteral calculi expulsion rate (pooled RR: 1.34; 95% CI 1.12, 1.61). 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), although significant inter-study heterogeneity was noted. Only minor gastrointestinal adverse effect was reported on terpene compound drug use.

CONCLUSIONS: The results suggest that terpene compound drug as MET is effective in promoting passage of ureterolithiasis. High quality large-scale RCTs comparing alpha-blockers and terpene compound drug are warranted to make a more definitive conclusion.

Publication Type
Publication Sub Type
Journal Article, Original
Philippine Journal of Urology
Publication Date
July-December 2012
LocationLocation CodeAvailable FormatAvailability
Philippine Council for Health Research and Development Library Box No. 9 Fulltext Print Format (Request Document)
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1. Pearle, M S, Calhoun, E A, Curhan, G C. "Urologic disease in America project: Urolithiasis" J Urol 173, 848-857, 2005
2. Hyams, E S, Korley, F K, Pham, J C, Matlaga, B R. "Trends in imaging use during the emergency department evaluation of flank pain" J Urol 186, 2270-2274, 2011
3. Teichman, JM H. "Acute renal colic from ureteral calculus" N Engl J Med 350, 684-693, 2004
4. Turk, C , Knoll, T , Petrik, A , Sarica, K , Straub, M , Seitz, C . "Guidelines on urolithiasis. Arnhem, the Netherlands: European Association of Urology" , 2012
5. "EAU / AUA Nephrolithiasis Guidelines Panel. 2007 Guidelines for the Management of Ureteral Calculi. AUA Education and Research, Inc." , 2007
6. Kallidonis, P , Liourdi, D , Liatsikos, E . "Medical treatment for renal colic and stone expulsion" Eur Urol 10, 415-422, 2011
7. Seitz, C . "Medical expulsive therapy of ureteral calculi and supportive therapy after extracorporeal shock wave lithotripsy" Eur Urol 9, 807-813, 2010
8. Geinitz, W . "The prevention of urinary calculi by Rowatinex in animal experiments" Munch Med Wochenschr 98, 895-897, 1956
9. Asai, J , Tsay, Y C, Miyake, K , Makino, M . "Treatment of urolithiasis with a terpene preparation, Rowatinex. Nagoya, Japan:" Department of Urology, Nagoya University , 1959
10. Bach, T . "Preclinical and clinical overview of terpenes in the treatment of urolithiasis" Eur Urol 9, 814-818, 2010
11. Higgins, JP T, Green , S . "Cochrane Handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration" , 2011. Retrieved from:
12. Duval, S , Tweedie, R . "Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis" Biometrics 56, 455-463, 2000
13. "Review Manager (Revman) [program]. Nordic Cochrane Center, Cochrane Collaboration" , 2008
14. Moher, D , Liberati, A , Tetzlaff, J , Altman, D G. "Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement" PLoS Med 2009(6:e1000097): 2009
15. Mukamel, E , Engelstein, D , Simon, D , Servadio, C . "The value of Rowatinex in the treatment of ureterolithiasis" J Urol(Paris) 93(1): 31-33, 1987
16. Engelstein, D , Kahan, E , Servadio, C . "Rowatinex for the treatment of ureterolithiasis" J Urol (Paris) 98(2): 98-100, 1992
17. Bak, C W, Yoon, S J, Chung, H . "Effects of an alpha-blocker and terpene mixture for pain control and spontaneous expulsion of ureter stone" Korean J Urol 48(5): 517-521, 2007
18. Faragi, G , Mullerad, M , Rub, R , Gremitsky, A , Jolkowsky, E , Marazka, H , Erlich, N . "Prospective study comparing rowatinex, alfuzosin and treatment with both for lower ureteral stones" Eur Urol 7(3): 149, 2008
19. Aldemir, M , Ucgul, Y E, Kayigil, O . "Evaluation of the efficiency of tamsulosin and rowatinex in patients with distal ureteral stones: A prospective, randomized, controlled study" Int Urol Nephrol 43(1): 79-83, 2011
20. Tholl, D . "Terpene synthases and the regulation, diversity and biological roles of terpene metabolism" Curr Opin Plant BioI 9, 1-8, 2006
21. Gershenzon, J , Dudareva, N . "The function of terpene natural products in the natural world" Nature Chern BioI 3, 408 - 414., 2007
22. Cipriani, P , Mancini, C . "Microbiological activity of a terpene product used in the treatment of urinary diseases" Gaz Int Mede Chir , 77, 1972
23. Horvath, N . "The use and effect of the terpenes in nephrolithiasis" Arztliche Praxis 15, 1521-1528, 1963
24. Lorenz, T , Lorenz, J , Szczudlowska-Chelsto, G . "Observations on the treatment of urolithiasis with essential oils" Pol Tyg Lek 16, 1608-1612, 1961
25. Stern, P , Vukcevic, S . "On influencing of nephrocalcinosis in rats" J Urol 53, 59-63, 1960
26. Kohlert, C , Rensen van, I , Marz, R , Schindler, G , Graefe, E U, Veit, M . "Bioavailability and pharmacokinetics of natural volatile terpenes in animals and humans" Planta Med 66, 495-505, 2000
27. AI-Mosawi, A J. "Essential oil terpenes: adjunctive role in the management of childhood urolithiasis" J Med Food 13, 247-250, 2010
28. Echeverrigaray, S , Michelim, L , Delamare, AP L, Andrade, C P, Pinto da Costa, S O, Zacaria, J . "The effect of monoterpenes on swarming differentiation and haemolysin activity in Proteus mirabilis" Molecules 13, 3107-3116;, 2008
29. Lee, C B, Ha, U S, Lee, S J, Kim, S W, Cho, Y H. "Preliminary experience with a terpene mixture versus ibuprofen for treatment of category III chronic prostatitis/ chronic pelvic pain syndrome" World J Urol 24, 55-60, 2006
30. Weiss, R M. "Physiology and pharmacology of the renal pelvis and ureter. In: Wein AJ (ed) Campbell-Walsh Urology" Philadelphia: Saunders 3(10th ed): 1779-1780, 2012
31. Romics, I , Siller, G , Kohnen, R , Mavrogenis, S , Varga, J , Holman, E . "Improving stone clearance after extracorporeal shock wave lithotripsy in urolithiasis patients by a special terpene combination (Rowatinex): Results of a placebo-controlled, randomized trial" Eur Urol 9, 819-825, 2010
32. Djaladat, H , Mahouri, K , Shooshtary, F K, Ahmadieh, A . "Effect of rowatinex on calculus clearance after extracorporeal shock wave lithotripsy" Urol J 6, 9-13, 2009
33. Davenport, K , Timoney, A , Keeley, F X. "A comparative in vitro study to determine the beneficial effect of calcium-channel and alpha (1)-adrenoceptor antagonism on human ureteric activity" BJU lnt 98, 651-655, 2006
34. Yilmaz, E , Batislam, E , Basar, M M, Tuglu, D , Ferhat, M , Basar, H . "The comparison and efficacy of 3 different alpha1 - adrenergic blockers for distal ureteral stones" J Urol 173, 2010-2012, 2005

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