The role of Silodosin as a new medical expulsive therapy for ureteral stones: a meta-analysis

Abstract

To evaluate the efficacy of Silodosin as a medical expulsive therapy of ureteral stones, we searched PubMed, EMBASE, the Cochrane Library, and CBM up to June 2015. All randomized controlled trials (RCTs) were identified in which patients were randomized to receive Silodosin versus placebo or other therapies for ureteral stones. Outcome measures assessed were overall stone expulsion rate (primary) and expulsion time, analgesics times, and the incidence of additional treatment and regarding treatment complications (secondary). Two authors independently assessed study quality and extracted data. All data were analyzed using RevMan 5.3. Seven RCTs with a total of 1035 patients met the inclusion criteria. The pooled meta-analysis showed a significant improvement in stone clearance with Silodosin (Silodosin versus placebo, OR ¼1.69, 95% CI [1.19-2.40], p ¼ 0.003; Silodosin versus tamsulosin, OR ¼2.82, 95% CI [1.79-4.44], p < 0.00001). According to the size and location of ureteral stone, the pooling effects of Silodosin were analyzed, with a meaningful expulsion rate in distal ureteral stone when the size was 5-10 mm. In addition, a shorter expulsion time, fewer analgesics times, and additional treatments were observed. The common side effect was retrograde ejaculation. In summary, Silodosin appears to be more effective than either placebo or tamsulosin. Within the limits of available data, highquality multicenter RCTs are needed to thoroughly evaluate the outcome in the future. ARTICLE HISTORY

Silodosin versus tamsulosin for medical expulsive treatment of ureteral stones: A systematic review and meta-analysis

“…Several previous systematic reviews and meta-analyses investigated silodosin versus tamsulosin for the treatment of ureteral stones [ 7 – 11 ]. The most recent study by Liu and colleagues [ 9 ] identified only five RCTs that yielded a pooled risk ratio of 1.25 (95% CI: 1.13 to 1.37), favoring silodosin over tamsulosin.…”

“…For adverse events, we found no risk differences of common adverse effects, including headaches, dizziness, backache, nasal congestion, gastrointestinal effects, and postural hypotension, between silodosin and tamsulosin. By contrast, retrograde ejaculation was another common major side effect, and previous meta-analyses also showed that there was no significant difference between silodosin and tamsulosin in terms of retrograde ejaculation [ 7 – 11 ]. However, in the present meta-analysis, the results showed that silodosin may have a higher risk by 5% compared with tamsulosin for retrograde ejaculation, which contributed to higher total adverse events in the silodosin group.…”

“…Silodosin, a recently introduced selective α-blocker, has a much higher selectivity for the α-1A receptor. Recent meta-analyses that included few randomized controlled trials (RCTs) demonstrated that silodosin is superior to tamsulosin for the expulsion of ureteral stones [ 7 – 11 ]. However, those studies had important limitations, including low numbers and small sample sizes of the RCTs, which made it difficult to perform a subgroup analysis of stone sizes, which affects the probability of spontaneous passage.…”

Efficacy and Safety of Alpha-Blockers for Kidney Stones in Adults

“…The most commonly studied primary endpoint was clearance or expulsion rate, which was successful passing of the stone. [8][9][10][11][12][13][14][15][16][17][18][19][20][21] A summary of studies can be found in Table 2.…”

“…9 There are published meta-analyses for each of the selective alpha-blockers (alfuzosin, silodosin, tamsulosin) and one that evaluated all alpha-blockers (selective and nonselective). [10][11][12][13] The tamsulosin meta-analysis included more than 2700 patients from 29 trials and found a 33% improvement in clearance rate with tamsulosin (0.2 mg and 0.4 mg daily) compared with control. Tamsulosin cleared stones more than calcium channel blockers (6 studies).…”