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

Abstract

ObjectiveMedical expulsive therapy (MET) is a suitable option for facilitating stone expulsion in patients with distal ureteral stones. This meta-analysis was conducted to compare the efficacy of tamsulosin, silodosin, tadalafil monotherapy, and combinations on stone expulsion rate (SER) and stone expulsion time (SET), as well as their comparative safety, number of colic pain episodes, and need for analgesics. MethodsRandomized controlled trials were retrieved by searching PubMed, Scopus, and Web of Science up to November 27, 2023. 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. ResultsIn total, 27 studies were identified. More than half of them (n=15, 55.6%) were conducted in India. 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=0.040) without any difference in SET. Subgroup analysis of 5- and 10-mg doses of tadalafil showed no significant difference in SER and SET. We found no significant difference in need for analgesic (mean difference [MD −53.73, p=0.200) or the mean number of colic episodes (MD −0.42, p=0.06) between tadalafil and tamsulosin. SER and SET were 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 the adverse effects. ConclusionCompared 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 METs had comparable safety.