Mohab Alsaid Saad Abdalaziz, Yousif Ahmad Hanafi, Belal Mohamed Hamed, Omar Fayez Abbas, Khaled Omar Mahmoud Khader, Mohammad Kh Alzawahreh, Hesham Ghzayel, Rashed Yousef Al Sharqi, Zaid F Altawallbeh
{"title":"西洛多辛是否优于他达拉非作为输尿管下段结石的医学排尿治疗？","authors":"Mohab Alsaid Saad Abdalaziz, Yousif Ahmad Hanafi, Belal Mohamed Hamed, Omar Fayez Abbas, Khaled Omar Mahmoud Khader, Mohammad Kh Alzawahreh, Hesham Ghzayel, Rashed Yousef Al Sharqi, Zaid F Altawallbeh","doi":"10.4081/aiua.2025.13642","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>This meta-analysis aims to compare the efficacy and safety of tadalafil and silodosin as medical expulsive therapy (MET) for lower ureteric stones below 10 mm. The study also assesses the incidence of adverse effects associated with each drug.</p><p><strong>Methods: </strong>A comprehensive search of electronic databases was conducted up to October, 2024. The study included randomized controlled trials (RCTs) and cohort studies that compared tadalafil and silodosin in patients with lower ureteric stones (5-10 mm). The primary outcomes assessed were stone expulsion time (SET), stone expulsion rate (SER), and adverse effects. Data were analyzed using a random-effects model for heterogeneity and a fixed-effect model for non-heterogeneity.</p><p><strong>Results: </strong>Eight studies involving 797 patients were included. The pooled analysis showed no significant difference in SET between tadalafil and silodosin (MD = 0.15, 95% CI [-0.28, 0.57], p=0.50), with significant heterogeneity. Similarly, the pooled analysis showed no significant difference in SER between the two drugs (RR = 0.92, 95% CI [0.80 to 1.05], p=0.22), with heterogeneity. However, after excluding one study, silodosin was favored over tadalafil for SER (RR 0.88, 95% CI [0.79 to 0.98], p=0.02). There were no significant differences in headache, backache, or dizziness. Silodosin was associated with a higher incidence of orthostatic hypotension, but this was resolved by excluding one study. A significant difference for abnormal ejaculation favored tadalafil (RR = 0.16, 95% CI [0.09 to 0.29], p=0.01).</p><p><strong>Conclusions: </strong>While the pooled results initially showed no significant difference in SET and SER, silodosin demonstrated a superior stone expulsion rate after adjusting for heterogeneity silodosin showed a trend towards shorter SET. However, silodosin was associated with a higher risk of orthostatic hypotension and abnormal ejaculation. Further high-quality RCTs with larger sample sizes are needed to confirm these findings.</p>","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":" ","pages":"13642"},"PeriodicalIF":1.3000,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Is silodosin better than tadalafil as a medical expulsive therapy in lower ureter stones?\",\"authors\":\"Mohab Alsaid Saad Abdalaziz, Yousif Ahmad Hanafi, Belal Mohamed Hamed, Omar Fayez Abbas, Khaled Omar Mahmoud Khader, Mohammad Kh Alzawahreh, Hesham Ghzayel, Rashed Yousef Al Sharqi, Zaid F Altawallbeh\",\"doi\":\"10.4081/aiua.2025.13642\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>This meta-analysis aims to compare the efficacy and safety of tadalafil and silodosin as medical expulsive therapy (MET) for lower ureteric stones below 10 mm. The study also assesses the incidence of adverse effects associated with each drug.</p><p><strong>Methods: </strong>A comprehensive search of electronic databases was conducted up to October, 2024. The study included randomized controlled trials (RCTs) and cohort studies that compared tadalafil and silodosin in patients with lower ureteric stones (5-10 mm). The primary outcomes assessed were stone expulsion time (SET), stone expulsion rate (SER), and adverse effects. Data were analyzed using a random-effects model for heterogeneity and a fixed-effect model for non-heterogeneity.</p><p><strong>Results: </strong>Eight studies involving 797 patients were included. The pooled analysis showed no significant difference in SET between tadalafil and silodosin (MD = 0.15, 95% CI [-0.28, 0.57], p=0.50), with significant heterogeneity. Similarly, the pooled analysis showed no significant difference in SER between the two drugs (RR = 0.92, 95% CI [0.80 to 1.05], p=0.22), with heterogeneity. However, after excluding one study, silodosin was favored over tadalafil for SER (RR 0.88, 95% CI [0.79 to 0.98], p=0.02). There were no significant differences in headache, backache, or dizziness. Silodosin was associated with a higher incidence of orthostatic hypotension, but this was resolved by excluding one study. A significant difference for abnormal ejaculation favored tadalafil (RR = 0.16, 95% CI [0.09 to 0.29], p=0.01).</p><p><strong>Conclusions: </strong>While the pooled results initially showed no significant difference in SET and SER, silodosin demonstrated a superior stone expulsion rate after adjusting for heterogeneity silodosin showed a trend towards shorter SET. However, silodosin was associated with a higher risk of orthostatic hypotension and abnormal ejaculation. Further high-quality RCTs with larger sample sizes are needed to confirm these findings.</p>\",\"PeriodicalId\":46900,\"journal\":{\"name\":\"Archivio Italiano di Urologia e Andrologia\",\"volume\":\" \",\"pages\":\"13642\"},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2025-06-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archivio Italiano di Urologia e Andrologia\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.4081/aiua.2025.13642\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/4/17 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archivio Italiano di Urologia e Andrologia","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4081/aiua.2025.13642","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/17 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：本荟萃分析旨在比较他达拉非和西洛多辛作为药物排出治疗输尿管下段小于10毫米结石的疗效和安全性。该研究还评估了与每种药物相关的不良反应发生率。方法：全面检索截至2024年10月的电子数据库。该研究包括随机对照试验（rct）和队列研究，比较了他达拉非和西洛多辛在输尿管下段结石（5-10毫米）患者中的作用。评估的主要结局是结石排出时间（SET）、结石排出率（SER）和不良反应。数据分析采用随机效应模型分析异质性，采用固定效应模型分析非异质性。结果：纳入8项研究，涉及797例患者。合并分析显示，他达拉非与西洛多辛的SET无显著差异（MD = 0.15, 95% CI [-0.28, 0.57], p=0.50），异质性显著。同样，合并分析显示两种药物SER无显著差异（RR = 0.92, 95% CI [0.80 ~ 1.05], p=0.22），存在异质性。然而，在排除一项研究后，西洛多辛优于他达拉非治疗SER （RR 0.88, 95% CI [0.79 ~ 0.98], p=0.02）。在头痛、背痛或头晕方面没有显著差异。西洛多辛与直立性低血压的高发生率相关，但通过排除一项研究解决了这一问题。他达拉非对射精异常有显著性影响（RR = 0.16, 95% CI [0.09 ~ 0.29], p=0.01）。结论：虽然汇集的结果最初显示SET和SER没有显著差异，但在调整异质性后，西洛多辛显示出更高的结石排出率。西洛多辛显示出更短的SET趋势。然而，西洛多辛与直立性低血压和射精异常的高风险相关。需要更大样本量的高质量随机对照试验来证实这些发现。
Is silodosin better than tadalafil as a medical expulsive therapy in lower ureter stones?
Objective: This meta-analysis aims to compare the efficacy and safety of tadalafil and silodosin as medical expulsive therapy (MET) for lower ureteric stones below 10 mm. The study also assesses the incidence of adverse effects associated with each drug.
Methods: A comprehensive search of electronic databases was conducted up to October, 2024. The study included randomized controlled trials (RCTs) and cohort studies that compared tadalafil and silodosin in patients with lower ureteric stones (5-10 mm). The primary outcomes assessed were stone expulsion time (SET), stone expulsion rate (SER), and adverse effects. Data were analyzed using a random-effects model for heterogeneity and a fixed-effect model for non-heterogeneity.
Results: Eight studies involving 797 patients were included. The pooled analysis showed no significant difference in SET between tadalafil and silodosin (MD = 0.15, 95% CI [-0.28, 0.57], p=0.50), with significant heterogeneity. Similarly, the pooled analysis showed no significant difference in SER between the two drugs (RR = 0.92, 95% CI [0.80 to 1.05], p=0.22), with heterogeneity. However, after excluding one study, silodosin was favored over tadalafil for SER (RR 0.88, 95% CI [0.79 to 0.98], p=0.02). There were no significant differences in headache, backache, or dizziness. Silodosin was associated with a higher incidence of orthostatic hypotension, but this was resolved by excluding one study. A significant difference for abnormal ejaculation favored tadalafil (RR = 0.16, 95% CI [0.09 to 0.29], p=0.01).
Conclusions: While the pooled results initially showed no significant difference in SET and SER, silodosin demonstrated a superior stone expulsion rate after adjusting for heterogeneity silodosin showed a trend towards shorter SET. However, silodosin was associated with a higher risk of orthostatic hypotension and abnormal ejaculation. Further high-quality RCTs with larger sample sizes are needed to confirm these findings.
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