Guo Yicheng, Sun Fengze, Wang Yini, Li Yanfei, Wang Tianqi, Ma Xiaohong, Wu Jitao
Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China.
The Second Clinical Medical College, Binzhou Medical University, Yantai, China.
Front Pharmacol. 2025 Mar 19;16:1517979. doi: 10.3389/fphar.2025.1517979. eCollection 2025.
To systematically evaluate the efficacy and safety of mirabegron compared to α-adrenergic receptor antagonists for treating distal ureteral stones.
A comprehensive search of EMBASE, PubMed, and Cochrane databases was conducted to identify studies comparing mirabegron and α-adrenergic receptor antagonists for stone expulsion. The primary outcome was stone expulsion rate (SER), and secondary outcomes included stone expulsion interval (SEI) and pain episode frequency. Risk ratio (RR) and mean differences (MD) with 95% CIs were calculated.
Six studies involving 487 participants were included. There was no significant difference in SER between mirabegron and α-adrenergic receptor antagonists (RR = 1.06; 95% CI = 0.93-1.22; P = 0.34). SEI showed no significant difference either (MD = 0.05; 95% CI = -3.23 to 3.34; P = 0.58). However, pain episodes were significantly reduced in the mirabegron group (MD = -0.36; 95% CI = -0.63 to -0.09; P = 0.01). Subgroup analysis showed reduced pain episodes with mirabegron versus silodosin but not tamsulosin. Mirabegron also had fewer side effects like headache (RR = 0.34; 95% CI = 0.13-0.87; P = 0.02) and orthostatic hypotension (RR = 0.11; 95% CI = 0.02-0.55; P = 0.008), while dizziness and ejaculation dysfunction rates were comparable.
Mirabegron reduced pain episodes during treatment for distal ureteral stones, particularly when compared to silodosin, despite no significant differences in SER or SEI. Its favorable safety profile suggests potential as a therapeutic option. Further randomized controlled trials are needed to confirm these findings.
系统评价米拉贝隆与α-肾上腺素能受体拮抗剂治疗远端输尿管结石的疗效和安全性。
全面检索EMBASE、PubMed和Cochrane数据库，以识别比较米拉贝隆和α-肾上腺素能受体拮抗剂排石情况的研究。主要结局是结石排出率（SER），次要结局包括结石排出间隔（SEI）和疼痛发作频率。计算风险比（RR）和95%置信区间的均值差（MD）。
纳入6项研究，共487名参与者。米拉贝隆与α-肾上腺素能受体拮抗剂的SER无显著差异（RR = 1.06；95% CI = 0.93 - 1.22；P = 0.34）。SEI也无显著差异（MD = 0.05；95% CI = -3.23至3.34；P = 0.58）。然而，米拉贝隆组的疼痛发作显著减少（MD = -0.36；95% CI = -0.63至-0.09；P = 0.01）。亚组分析显示，与西洛多辛相比，米拉贝隆可减少疼痛发作，但与坦索罗辛相比则不然。米拉贝隆的副作用也较少，如头痛（RR = 0.34；95% CI = 0.13 - 0.87；P = 0.02）和体位性低血压（RR = 0.11；95% CI = 0.02 - 0.55；P = 0.008），而头晕和射精功能障碍发生率相当。
尽管在SER或SEI方面无显著差异，但米拉贝隆在治疗远端输尿管结石期间可减少疼痛发作，尤其是与西洛多辛相比。其良好的安全性表明它有作为一种治疗选择的潜力。需要进一步的随机对照试验来证实这些发现。
