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Which Combination of Medical Expulsive Therapy Is More Effective for Treatment of Distal Ureteral Stone in Adults? a Systematic Review and Network Meta-Analysis Publisher Pubmed



Taheri M1 ; Borumandnia N1, 2 ; Abdi H3 ; Kashi AH4 ; Nourani S5 ; Sheikholeslami S6 ; Gilvaei YM7 ; Ziaeefar P1 ; Basiri A4
Authors
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Authors Affiliations
  1. 1. Urology and Nephrology Research Center, Research Institute for Urology and Nephrology, Shahid Beheshti University of Medical Sciences, P.O. Box: 1666663111, No. 103, Shahid Jafari (9th Boostan) St., Pasdaran Ave., Tehran, Iran
  2. 2. Department of Epidemiology and Biostatistics, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
  3. 3. Department of Surgery, Western University, London, ON, Canada
  4. 4. Urology and Nephrology Research Center (UNRC), Research Institute for Urology and Nephrology, Center of Excellence in Urology, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
  5. 5. School of Medicine, Lorestan University of Medical Sciences, Lorestan, Iran
  6. 6. Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
  7. 7. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

Source: BMC Urology Published:2025


Abstract

Background: Medical Expulsive Therapy (MET) has been recommended as an established modality for the treatment of distal ureteral stones due to its clearance rate, pain control, and patient satisfaction while having minimal morbidity in comparison to other urologic interventions. In some studies, a combination of medications has been used, which we assessed in this network meta-analysis (NMA). Methods: We conducted systematic searches in PubMed, Scopus, and Web of Science to identify relevant trials published between 2001 and 2024. We excluded articles that looked at MET for upper ureteral stone passage or after shock wave lithotripsy (SWL). NMA was performed to compare the effect of combination MET on stone expulsion rate (SER), stone expulsion time (SET), and need for analgesia. Results: We included 19 studies with 2414 participants. NMA results revealed that the combination MET of α-blockers with PDE-5 inhibitors (OR = 2.7, CI = 1.80,4.05), corticosteroids (OR = 2.7, CI = 1.81,4.13), and phytotherapy (OR: 3.10, CI = 1.62,5.92) were more effective than α-blockers alone in SER. The combination MET of α-blockers with PDE-5 inhibitors (MD: -3.8, CI=-7.0, -0.5) showed significantly lower SET compared to α-blockers alone. Finally, combination MET of α-blockers with PDE-5 inhibitors (MD:1.0, CI = 0.4,1.7) and nifedipine with corticosteroids (MD:1.2, CI = 0.4,1.9) showed a significant decrease in analgesia use. Conclusions: The combination MET of α-blockers with PDE-5 inhibitors, corticosteroids, and phytotherapy increases the rate of stone clearance 2.7 to 3.1 times more than α-blockers alone. The other benefits of combination MET were lower expulsion time and less analgesia use that needs further studies. © The Author(s) 2024.
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