Efficacy and safety of phosphodiesterase type 5 inhibitors for the treatment of distal ureteral calculi of 5 to 10 mm in size: A systematic review and network meta‐analysis

Abstract

To evaluate the Efficacy and safety of phosphodiesterase type 5 inhibitors as a medical therapy for distal ureteral calculi by means of a systematic review and network meta‐analysis (NMA). We searched the Embase, Medline, and the Cochrane Central Register of Controlled Trials for randomised controlled trials (RCTs) published before May, 2017. Stone passage rate as the primary outcome. We used random effects model for pairwise meta‐analyses and Bayesian random effects model for NMA. We evaluated the quality of evidence by the GRADE framework for each network estimate. Five RCTs (861 patients) comparing four different interventions. The results of NMA showed that compared with tamsulosin alone, tamsulosin combined with tadalafil group was associated with significantly higher stone passage rate (odds radio [OR] 2.55, 95% credible intervals [Crl] 1.11 to 5.89). When considering stone expulsion rate, compared with tamsulosin, silodosin was ranked best (OR 3.58, 95% Crl 1.13 to 11.91), followed by tamsulosin combined with tadalafil (OR 2.55, 95% Crl 1.11 to 5.89) and tadalafil alone (OR 1.86, 95% Crl 0.95 to 4.25). No significant difference was found considering safety profiles between any interventions. This meta‐analysis indicates that tamsulosin combined with tadalafil is an effective treatment option for ureteral stones with a low occurrence of side effects. Clinicians should take all known safety and compliance of patients into account when choosing an optimal strategy. Since sample size of included studies, further RCTs are strongly encouraged to address the clinical question.

Efficacy of tamsulosin versus tadalafil as medical expulsive therapy on stone expulsion in patients with distal ureteral stones: A randomized double-blind clinical trial

“…Even meta-analyzes have reported conflicting results. While a meta-analysis by Li et al (24) showed that the time to expel stones in tadalafil group was significantly less than tamsulosin group (p=0.028), another meta-analysis by Liu et al, (25) in the same year reported no significant shorter stone expulsion time for tadalafil in comparison with tamsulosin.…”

“…Liu et al (25), in their meta-analysis, showed that using tadalafil is associated with more side effects such as headache, dizziness, backache, and orthostatic hypotension than tamsulosin. But another meta-analysis by Li et al (24), reported no statistic difference between tamsulosin group and tamsulosin plus tadalafil group in terms of drug's adverse effects (p >0.05).…”

“…In the study of Al-Hossona et al (23), tadalafil significantly improved stone expulsion in comparison with placebo. Also, many studies and meta-analysis showed that tamsulosin combined with tadalafil was associated with significantly higher stone expulsion rate compared with tamsulosin alone (21,24,25),…”

“…However, in 2019, Li et al (24) in a meta--analysis showed that dosage of analgesia used in tadalafil group was significantly higher than tamsulosin group and the duration of analgesia use in patients who used tamsulosin plus tadalafil were significantly lower than those who received tamsulosin alone.…”

“…Recently, however, many studies have been conducted to assess the effect of tadalafil on stone expulsion and have attracted the attention of urologists to use this drug as a MET, the findings of meta-analysis do not support complete replacement of tamsulosin with tadalafil and they only suggest that combination of tadalafil and tamsolusin in MET may reduce the need for SWL therapy and minimally invasive procedures (24,25). Even in the EAU Guidelines 2020, the role of tadalafil in MET for distal ureteral stones has not been proved.…”