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Comparing Efficacy and Safety of Monotherapy and Combination Therapy With Tadalafil, Tamsulosin, and Silodosin for Distal Ureteral Stones: A Systematic Review and Meta-Analysis Publisher



Ebrahimpour S1, 2 ; Kargar M3 ; Balvardi M4 ; Tabatabaeimalazy O5, 6 ; Asadi P7 ; Mohammadi M1, 8
Authors
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Authors Affiliations
  1. 1. Department of Clinical Pharmacy, School of Pharmacy, Alborz University of Medical Sciences, Karaj, Iran
  2. 2. Pharmaceutical Care Department, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran
  3. 3. Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
  5. 5. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
  6. 6. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
  7. 7. School of Medicine, Zhejiang University, Hangzhou, China
  8. 8. Pharmaceutical Care Department, Imam Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran

Source: Asian Journal of Urology Published:2025


Abstract

Objective: Medical expulsive therapy (MET) is a suitable option for facilitating stone expulsion in patients with distal ureteral stones. This meta-analysis was conducted to compare efficacy and safety of monotherapy and combination therapy with tamsulosin, silodosin, and tadalafil on stone expulsion rate (SER) and stone expulsion time (SET), as well as their comparative safety, numbers of colic pain episodes, and need for analgesics. Methods: Randomized controlled trials were retrieved by searching PubMed, Scopus, and Web of Science up to November 27, 2023. Hand-searching was also conducted in Google Scholar to find additional records. Papers in English that compared the safety and efficacy of at least two of the above agents in adults with distal ureteral stones ≤10 mm were included. Results: In total, 27 studies were identified (six studies through database searches and 21 through checking reference lists and hand-searching in Google Scholar). More than half of them (n=15, 56%) were conducted in India. The SER significantly improved with silodosin compared with tamsulosin (odds ratio [OR] 2.24, p<0.001), whereas the difference in SET was non-significant. Tadalafil achieved a significantly higher SER compared with tamsulosin (OR 1.42, p=0.042) without any difference in SET. Subgroup analysis of 5- and 10-mg doses of tadalafil showed no significant difference in SER or SET. We found no significant difference in need for analgesics (mean difference [MD −53.73, p=0.2) or the mean number of colic episodes (MD −0.42, p=0.060) between tadalafil and tamsulosin. SER or SET was not significantly different between silodosin and tadalafil. Tadalafil plus tamsulosin led to a significantly higher SER (OR 1.87, p<0.001) and SET (MD −2.99, p=0.002) compared with tamsulosin, without any significant difference in adverse effects. Conclusion: Compared with tamsulosin, SER significantly improved with silodosin, tadalafil, and the combination of tadalafil plus tamsulosin. Meanwhile, the difference in SET was only significant between tadalafil plus tamsulosin versus tamsulosin. It appears that tadalafil and silodosin have similar efficacy in SET and SER. All medical expulsive therapies had comparable safety. © 2025 Editorial Office of Asian Journal of Urology
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1. Which Combination of Medical Expulsive Therapy Is More Effective for Treatment of Distal Ureteral Stone in Adults? a Systematic Review and Network Meta-Analysis, BMC Urology (2025)