Comparing efficacy and safety of monotherapy and combination therapy with tadalafil, tamsulosin, and silodosin for distal ureteral stones: A systematic review and meta-analysis

IF 2.4 3区医学 Q2 UROLOGY & NEPHROLOGY

Asian Journal of Urology Pub Date : 2025-04-01 DOI:10.1016/j.ajur.2024.05.003

Sholeh Ebrahimpour , Mona Kargar , Mohadeseh Balvardi , Ozra Tabatabaei-Malazy , Pardis Asadi , Mehdi Mohammadi

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引用次数: 0

Abstract

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.

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比较他达拉非、坦索罗辛和西洛多辛治疗输尿管远端结石的单药和联合治疗的疗效和安全性：一项系统综述和荟萃分析

目的药物排出治疗输尿管远端结石是一种促进结石排出的合适方法。本荟萃分析旨在比较坦索罗新、西洛多新和他达拉非单药治疗和联合治疗在结石排出率（SER）和结石排出时间（SET）方面的疗效和安全性，以及它们的相对安全性、绞痛发作次数和镇痛药需求。方法通过PubMed、Scopus和Web of Science检索到2023年11月27日的随机对照试验。在b谷歌Scholar中也进行了手工检索，以查找其他记录。纳入了至少两种以上药物对输尿管远端结石≤10 mm的成人患者的安全性和有效性进行比较的英文论文。结果共筛选到27篇研究（数据库检索6篇，参考文献检索和b谷歌Scholar手工检索21篇）。其中一半以上（n= 15.56%）是在印度进行的。与坦索罗辛相比，西洛多辛显著改善了SER（比值比[OR] 2.24, p<0.001），而SET的差异无统计学意义。他达拉非的SER明显高于坦索罗辛（OR 1.42, p=0.042）， SET无差异。他达拉非5毫克和10毫克剂量的亚组分析显示SER或SET无显著差异。我们发现他达拉非和坦索罗辛在镇痛药需求方面无显著差异（平均差异[MD - 53.73, p=0.2]）或平均绞痛发作次数（MD - 0.42, p=0.060）。西洛多辛与他达拉非间SER或SET无显著差异。与坦索罗辛相比，他达拉非联合坦索罗辛导致SER （OR 1.87, p<0.001）和SET （MD - 2.99, p=0.002）显著升高，不良反应无显著差异。结论与坦索罗辛相比，西洛多辛、他达拉非及他达拉非与坦索罗辛合用可显著改善SER。同时，SET仅在他达拉非联合坦索罗辛与坦索罗辛之间有显著差异。他达拉非和西洛多辛对SET和SER的疗效相似。所有的医学排斥疗法都具有相当的安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Asian Journal of Urology UROLOGY & NEPHROLOGY-

CiteScore

4.00

自引率

3.80%

发文量

100

审稿时长

4 weeks

期刊介绍： Asian Journal of Urology (AJUR), launched in October 2014, is an international peer-reviewed Open Access journal jointly founded by Shanghai Association for Science and Technology (SAST) and Second Military Medical University (SMMU). AJUR aims to build a communication platform for international researchers to effectively share scholarly achievements. It focuses on all specialties of urology both scientifically and clinically, with article types widely covering editorials, opinions, perspectives, reviews and mini-reviews, original articles, cases reports, rapid communications, and letters, etc. Fields of particular interest to the journal including, but not limited to: • Surgical oncology • Endourology • Calculi • Female urology • Erectile dysfunction • Infertility • Pediatric urology • Renal transplantation • Reconstructive surgery • Radiology • Pathology • Neurourology.