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 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 (=15, 56%) were conducted in India. The SER significantly improved with silodosin compared with tamsulosin (odds ratio [OR] 2.24, <0.001), whereas the difference in SET was non-significant. Tadalafil achieved a significantly higher SER compared with tamsulosin (OR 1.42, =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, =0.2) or the mean number of colic episodes (MD -0.42, =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, <0.001) and SET (MD -2.99, =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.