Comparison of efficacy of three commonly used alpha-blockers as medical expulsive therapy for distal ureter stones: A systematic review and network meta-analysis

Abstract

Introduction:The efficacy of alpha-blockers as medical expulsive therapy (MET) is well established. However, it is not known which of the three most commonly used alphablockers (tamsulosin, alfuzosin and silodosin) is the most efficacious. With this study we aimed to assess the efficacy of the three commonly used alpha-blockers as MET for distal ureter stones. Materials and Methods: For this review, we searched multiple databases such as PubMed/Medline, Scopus, Embase, OviD SP, CINAHL, and web of science to identify all the relevant randomized studies comparing the efficacy of tamsulosin, alfuzosin, and silodosin. Preferred reporting items for systematic reviews for network meta-analysis (PRISMA-NMA) were followed while conducting this review and the study protocol was registered with PROSPERO (CRD42020175706). Results: In this review, 31 studies with 7077 patients were included. Compared to placebo all the treatment groups were more effective for both stone expulsion rate (SER) and stone expulsion time (SET). For both SER and SET, silodosin had the highest SUCRA (94.8 and 90.4) values followed by alfuzosin (58.8 and 64.9) and tamsulosin (46.2 and 44.5). The incidence of postural hypotension was similar with all the drugs, whereas, the incidence of retrograde ejaculation was significantly higher for silodosin. Overall confidence for each comparison group in this review ranged from "very low" to "moderate" according to the CINeMA approach. Conclusion: Among the three commonly used alpha-blockers silodosin is the most efficacious drug as MET for lower ureter stones followed by alfuzosin and tamsulosin.

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

“…Furthermore, the findings of another meta-analysis demonstrated that silodosin was the most efficacious alpha-blocker as MET for distal ureteric stones (19). The results of two meta-analyses suggest that silodosin is more effective than tamsulosin for the spontaneous stone pass (19,22). However, in our study, we did not identify a better expulsion rate as MET with silodosin than with tamsulosin.…”

“…The others demonstrated that alpha-blockers had a significantly higher stone expulsion rate when compared to placebo (17,18). Despite contradictory results, a recent meta-analysis showed that there was a significantly better expulsion rate and lower mean expulsion time in tamsulosin, alfuzosin, and silodosin groups compared to placebo (19). The success rate for tamsulosin in distal ureteral stones smaller than 10 mm ranges between 50% and 87% (7,9,16,17).…”

“…Hsu et al conducted a meta-analysis to evaluate the effectiveness of silodosin and tamsulosin as MET for ureteral stones and concluded that silodosin had a significantly better stone passage rate for patients with ureteral stones compared to tamsulosin (22). Furthermore, the findings of another meta-analysis demonstrated that silodosin was the most efficacious alpha-blocker as MET for distal ureteric stones (19). The results of two meta-analyses suggest that silodosin is more effective than tamsulosin for the spontaneous stone pass (19,22).…”

Efficacy of Alpha-Adrenergic Receptor Antagonists in the Treatment of Distal Ureteric Stones: A Paediatric Study

“…Metaanalysis describing the efficacy of Silodosin and medical expulsive therapy evaluated the effect on pain management as pain episodes declined with Silodosin treatment and spontaneous passage of stones were increased within the first 14 days of treatment. 5,22,23 Silodosin has not been fully evaluated in the paediatric population as medical expulsive therapy, this study will be a beneficial contribution in literature especially in a developing country population where paediatric urolithiasis is on expansion and ongoing. The limitations of this study are a smaller sample size, and no CT KUB has been performed to assess the ureteric stones due to financial restraints.…”

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

“…The incidence of postural hypotension was similar with all the drugs, whereas silodosin emerged as the most efficacious drug as MET for lower ureter stones. 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.…”