Comparison of efficacy of various drugs used for medical expulsive therapy for distal ureter stones: A systematic review and network meta‐analysis

Abstract

Objectives Medical expulsive therapy has been found to be effective for distal ureteric stones; however, which drug is most efficacious in terms of stone expulsion rate (SER) and stone expulsion time (SET) is not known. With this review we aimed to compare the efficacy of various drug treatments for distal ureter stones used as medical expulsive therapy in terms of SER and SET. Methods Systematic literature search was conducted to include all the randomised study comparing various drug interventions for lower ureter stones. Standard preferred reporting items for systematic review and meta‐analysis for network meta‐analysis (PRISMA‐NMA) were pursued. Results In this review, 50 randomised studies with 12,382 patients were included. For stone expulsion rate (SER), compared with placebo all the treatment groups were more effective except nifedipine and sildenafil. According to the SUCRA values obtained, naftopidil plus steroid was the highest rank and nifedipine lowest. For stone expulsion time (SET), compared with placebo only tadalafil plus silodosin, nifedipine plus steroid, alfuzosin, silodosin, tadalafil and tamsulosin were more effective. SUCRA values were highest for tadalafil plus silodosin and least for naftopidil plus steroid. From subgroup analysis with individual drugs for SER, SUCRA values were highest for naftopidil followed by silodosin and SET was highest for silodosin and least for naftopidil. Conclusion For lower ureter stone, tadalafil plus silodosin is the best combination and silodosin best individual drug considering the SET and SER. Nifedipine as monotherapy is no more effective than control group.

Evolving Role of Silodosin for the Treatment of Urological Disorders – A Narrative Review

“…The patients administered with tamsulosin and naftopidil reported a worsening of health condition than those receiving silodosin. These findings suggest that silodosin may have an added advantage in management of LUTS after 125 I prostate brachytherapy compared with other α 1 -blockers. 116 A pressure flow study to check the urodynamics of silodosin treatment revealed a significantly enlarged bladder capacity when first non-voiding contraction was seen at 3 and 12 months (3M: 127.1 ± 74.8 vs 118.2 ± 83.9 mL, P = 0.001; 12M: 123.7 ± 79.3 vs 100.3 ± 73.4 mL, P = 0.01).…”

“… 124 The same researchers reported that a tadalafil plus silodosin combination and silodosin as an individual drug are the best for treating lower ureter stones considering the SET and SER. 125 A meta-analysis carried out by Liu et al reported similar findings stating that tadalafil plus silodosin has the highest probability of reducing SET, and treating ureteral stones ≤10 mm. 126 …”

“…124 The same researchers reported that a tadalafil plus silodosin combination and silodosin as an individual drug are the best for treating lower ureter stones considering the SET and SER. 125 A meta-analysis carried out by Liu et al reported similar findings stating that tadalafil plus silodosin has the highest probability of reducing SET, and treating ureteral stones ≤10 mm. 126 Considering that α-blockers show improved efficacy in various urological disorders, these findings could serve as an evidence-based practice and can be considered by physicians and researchers to develop clinical-based guidelines.…”

Efficacy of tamsulosin versus silodosin as medical expulsive therapy on stone expulsion in patients with distal ureteral stone: A retrospective single center study

“…The reason for a similar expulsion rate between silodosin and tamsulosin in our study may be due to the use low dose of silodosin. On the other hand, two recent meta-analyses found that the combination of different drugs was shown to be superior to the use of individual agents such as MET (8,23). The possible explanation for a higher success rate in combination therapy may be due to the different and more mechanisms of action.…”

Prevention, diagnosis, and treatment of urolithiasis in geriatric patients - differences, similarities and caveats in comparison to the general population

“…Although alpha-antagonists have been shown by meta-analyses to have an impact on MET [48][49][50], large placebo-controlled, double-blinded RCTs have not been able to show any significant benefits in various scenarios except for stones >5 mm in the distal ureter [51][52][53][54][55]. A recent systematic review and meta-analysis revealed that there was no significant difference in the effectiveness of calcium-channel inhibitor or PDEI5 monotherapy when compared to placebo; however, the combination proved to be effective mainly for distal ureter stones [56]. The 2023 EAU guidelines recommend alpha-antagonists for MET for distal ureteral stones larger >5 mm, however they are not specifically advised for elderly patients [11].…”