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

Abstract

Silodosin, a recently introduced selective α-blocker, has a much higher selectivity for the α-1A receptor. The efficacy and safety of silodosin compared to tamsulosin in medical expulsive therapy (MET) are controversial. The objective of this study was to assess the efficacy and safety of silodosin compared to tamsulosin for treating ureteral stones <10 mm in diameter. We systematically searched the PubMed, EMBASE, Cochrane library, and Scopus databases from their inception to May 2018. We included randomized controlled studies (RCTs) and observational studies, which investigated stone expulsion rates using silodosin compared to tamsulosin. Data were synthesized using a random-effects model. Sixteen studies with 1824 patients were eligible for inclusion. Silodosin achieved significantly higher expulsion rates than tamsulosin (pooled risk difference (RD): 0.13, 95% confidence interval (CI): 0.09 to 0.18, GRADE: high). A subgroup analyses showed that silodosin has a significantly higher expulsion rate on stone sizes of 5–10 mm than tamsulosin (pooled RD: 0.14, 95% CI: 0.06 to 0.22, I2 = 0%). The superior effect was not observed on stone sizes <5 mm. A multivariate regression showed that the RD was negatively associated with the control expulsion rate after adjusting for age and gender (coefficient -0.658, p = 0.01). A sensitivity analysis showed that our findings were robust. Patients receiving silodosin also probably had a significantly shorter expulsion time (pooled mean difference (MD): -2.55 days, 95% CI: -4.06 to -1.04, I2 = 85%, GRADE: moderate) and may have fewer pain episodes (pooled MD: -0.3, 95% CI: -0.51 to -0.09, GRADE: low) but a higher incidence of retrograde ejaculation by 5% compared to those receiving tamsulosin. In conclusion, compared to tamsulosin, silodosin provided significantly better stone passage for patients with ureteral stones (particularly for sizes of 5~10 mm), shorter expulsion times, and fewer pain episodes but caused a higher incidence of retrograde ejaculation.

Comparison of efficacy of various drugs used for medical expulsive therapy for distal ureter stones: A systematic review and network meta‐analysis

“…Shockwave lithotripsy and surgical procedures like URSL are not free of complication, thus, alternative conservative methods have been applied especially when stones are located in distal ureter and are less than 10 mm. Multiple drugs such as α-blockers (tamsulosin, silodosin, alfuzosin and naftopidil), [7][8][9] nifedipine (calcium channel blockers (CCBs)) 10 and phosphodiesterase inhibitors (PDEI) (sildenafil 11 and tadalafil 12 ) have been found to be effective in facilitating ureter stones compared with general measures such as use of non-steroidal inflammatory drugs (NSAIDS), hydration, antispasmodics, diuretics and placebo. Of these drugs tamsulosin has been widely studied and has been found to facilitate stone expulsion not only in distal but also other parts of ureter.…”

Does silodosin offer better results than tamsulosin as medical expulsive treatment after shock wave lithotripsy for single distal ureteric stones?

“…To our knowledge this retrospective study appears to be the first aiming to compare the effects of tamsulosin 0.4 mg with silodosin 4 mg and 8 mg as medical expulsive treatment after SWL. A recent meta-analysis showed that all the previous published studies compared tamsulosin 0.4 mg with silodosin 8 mg, revealing higher expulsion rates for silodosin 8 mg, none of them evaluating the effect of lower dose silodosin [ 11 ]. Although controversies exist, α-blocker therapy is recommended by the European Association of Urology Guidelines as medical expulsive treatment, especially for distal ureteric stones, facilitating the stone passage due to the relaxation of the smooth muscle of the ureter [ 12 ].…”

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

“…Also, these patients had fewer incidences of pain episodes (pooled MD: −0.3, 95% CI: −0.51, −0.09) compared with those receiving tamsulosin. 122 Ozsoy et al 123 compared the efficacy of silodosin with tamsulosin in a pooled data of 409 patients. The meta-analysis results favored • The mean change in the IPSS QoL index score at 3 months in the naftopidil, tamsulosin, and silodosin groups was +1.3, +1.4, and +0.9, respectively…”