Comparing efficacy and safety of monotherapy and combination therapy with tadalafil, tamsulosin, and silodosin for distal ureteral stones: A systematic review and meta-analysis
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 expulsio...
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Elsevier
2025-04-01
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| Series: | Asian Journal of Urology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214388224001152 |
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| author | Sholeh Ebrahimpour Mona Kargar Mohadeseh Balvardi Ozra Tabatabaei-Malazy Pardis Asadi Mehdi Mohammadi |
| author_facet | Sholeh Ebrahimpour Mona Kargar Mohadeseh Balvardi Ozra Tabatabaei-Malazy Pardis Asadi Mehdi Mohammadi |
| author_sort | Sholeh Ebrahimpour |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-c796c89b235f4c97b30bc288b2dbf76d |
| institution | OA Journals |
| issn | 2214-3882 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
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| series | Asian Journal of Urology |
| spelling | doaj-art-c796c89b235f4c97b30bc288b2dbf76d2025-08-20T02:11:22ZengElsevierAsian Journal of Urology2214-38822025-04-0112218920310.1016/j.ajur.2024.05.003Comparing efficacy and safety of monotherapy and combination therapy with tadalafil, tamsulosin, and silodosin for distal ureteral stones: A systematic review and meta-analysisSholeh Ebrahimpour0Mona Kargar1Mohadeseh Balvardi2Ozra Tabatabaei-Malazy3Pardis Asadi4Mehdi Mohammadi5Department of Clinical Pharmacy, School of Pharmacy, Alborz University of Medical Sciences, Karaj, Iran; Pharmaceutical Care Department, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, IranResearch Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, IranDepartment of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IranNon-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, IranSchool of Medicine, Zhejiang University, Hangzhou, ChinaDepartment of Clinical Pharmacy, School of Pharmacy, Alborz University of Medical Sciences, Karaj, Iran; Pharmaceutical Care Department, Imam Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran; Corresponding author. Department of Clinical Pharmacy, School of Pharmacy, Alborz University of Medical Sciences, Karaj, Iran.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.http://www.sciencedirect.com/science/article/pii/S2214388224001152TamsulosinTadalafilSilodosinDistal ureteral stoneExpulsion rateExpulsion time |
| spellingShingle | Sholeh Ebrahimpour Mona Kargar Mohadeseh Balvardi Ozra Tabatabaei-Malazy Pardis Asadi Mehdi Mohammadi Comparing efficacy and safety of monotherapy and combination therapy with tadalafil, tamsulosin, and silodosin for distal ureteral stones: A systematic review and meta-analysis Asian Journal of Urology Tamsulosin Tadalafil Silodosin Distal ureteral stone Expulsion rate Expulsion time |
| title | Comparing efficacy and safety of monotherapy and combination therapy with tadalafil, tamsulosin, and silodosin for distal ureteral stones: A systematic review and meta-analysis |
| title_full | Comparing efficacy and safety of monotherapy and combination therapy with tadalafil, tamsulosin, and silodosin for distal ureteral stones: A systematic review and meta-analysis |
| title_fullStr | Comparing efficacy and safety of monotherapy and combination therapy with tadalafil, tamsulosin, and silodosin for distal ureteral stones: A systematic review and meta-analysis |
| title_full_unstemmed | Comparing efficacy and safety of monotherapy and combination therapy with tadalafil, tamsulosin, and silodosin for distal ureteral stones: A systematic review and meta-analysis |
| title_short | Comparing efficacy and safety of monotherapy and combination therapy with tadalafil, tamsulosin, and silodosin for distal ureteral stones: A systematic review and meta-analysis |
| title_sort | comparing efficacy and safety of monotherapy and combination therapy with tadalafil tamsulosin and silodosin for distal ureteral stones a systematic review and meta analysis |
| topic | Tamsulosin Tadalafil Silodosin Distal ureteral stone Expulsion rate Expulsion time |
| url | http://www.sciencedirect.com/science/article/pii/S2214388224001152 |
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