, Volume 46, Issue 2, pp 211–218 | Cite as

Role of silodosin as medical expulsive therapy in ureteral calculi: a meta-analysis of randomized controlled trials

  • Xin-Jian Liu
  • Jian-Guo Wen
  • You-Dong Wan
  • Bo-Wen Hu
  • Qing-Wei Wang
  • Yan Wang
Original Paper


The objective of this study is to investigate the efficacy of silodosin in medical expulsive therapy (MET) for ureteral stones. We conducted a systematic review and meta-analysis to determine the efficacy and safety of silodosin in MET for ureteral calculi. We searched PubMed, Embase, Medline, Central (the Cochrane Library, Issue 1,2013), Google Scholar from the inception to March 2015 for randomized controlled trials (RCTs), comparing silodosin with tamsulosin or control on ureteral stone passage. Eight RCTs with a total of 1145 ureteral stone patients (300 patients in the control group, 287 patients in the tamsulosin group, 558 patients in the silodosin group) were included in this meta-analysis. When compared with control, silodosin significantly improved expulsion rate of distal ureteral stones (RR: 1.42; 95% CI, 1.21–1.67; P < 0.0001), while there was no significant difference between silodosin and the control in expulsion rate of proximal (RR: 0.99; 95% CI, 0.69–1.43; P < 0.97) or mid (RR: 1.13; 95% CI, 0.60–2.16; P < 0.0001) ureteral stones. There was no significant difference between silodosin and tamsulosin in terms of expulsion time (WMD: −2.47; 95% CI, −5.32 to 0.39; P = 0.09), analgesic use (WMD: −0.39; 95% CI, −0.91 to 0.13; P  = 0.14) and retrograde ejaculation rate (RR: 1.85; 95% CI, 0.95–3.59; P = 0.07) in MET for distal ureteral stones. However, silodosin provided a significantly higher expulsion rate (RR: 1.25; 95% CI, 1.13–1.37; P < 0.0001) than tamsulosin for distal ureteral stones. Silodosin significantly improved expulsion rate of distal ureteral stones and was clinically superior to tamsulosin. Silodosin was ineffective in MET for proximal and mid ureteral stones. More RCT studies are needed to compare the efficacy of silodosin versus tamsulosin in MET for distal ureteral stones.


Silodosin Tamsulosin Medical expulsive therapy Ureteral stones Expulsion rate 


Compliance with ethical standards


This study was funded by the National Natural Science Foundation (Grant number 81,370,869).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Tiselius HG (2003) Epidemiology and medical management of stone disease. BJU Int 91:758–767CrossRefPubMedGoogle Scholar
  2. 2.
    Chand RB, Shah AK, Pant DK et al (2013) Common site of urinary calculi in kidney, ureter and bladder region. Nepal Med Coll J 15:5–7PubMedGoogle Scholar
  3. 3.
    Bensalah K, Pearle M, Lotan Y (2008) Cost-effectiveness of medical expulsive therapy using alpha-blockers for the treatment of distal ureteral stones. Eur Urol 53:411–418CrossRefPubMedGoogle Scholar
  4. 4.
    Tiselius HG, Ackermann D, Alken P, et al. Guidelines on urolithiasis. European Association of Urology Web site. Accessed January 28, 2014
  5. 5.
    Porpiglia F, Vaccino D, Ogawa A et al (2006) Corticosteroids and tamsulosin in the medical expulsive therapy for symptomatic distal ureter stones: single drug or association? Eur Urol 50:339–344CrossRefPubMedGoogle Scholar
  6. 6.
    Bos D, Kapoor A (2014) Update on medical expulsive therapy for distal ureteral stones: Beyond alpha-blockers. Can Urol Assoc J 8:442–445CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analysis: the PRISMA statement. Ann Intern Med 151:264–269CrossRefPubMedGoogle Scholar
  8. 8.
    Kjaergard LL, Vilumsen J, Gluud C, et al (2001) Reported methodologic quality and discrepancies between large and small randomized trials in meta-analysis. Ann Interm Med 135:629–634CrossRefGoogle Scholar
  9. 9.
    Davies HT, Crombie IK, Tavakoli M (1998) When can odds ratio mislead? BMJ 316:989–991CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Egger M, Davey SG, Schneider M et al (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Sur RL, Shore N, L’Esperance J, et al (2014) Silodosin to facilitate passage of ureteral stones: a multi-institutional, randomized, double-blinded, placebo-controlled trial. Eur Urol. (Epub ahead of print)Google Scholar
  12. 12.
    Itoh Y, Okada A, Yasui T et al (2013) Administration of the selective alpha 1 A-adrenoceptor antagonist silodosin facilitates expulsion of size 5–10 mm distal ureteral stones, as compared to control. Int Urol Nephrol 45:675–678CrossRefPubMedGoogle Scholar
  13. 13.
    Itoh Y, Okada A, Yasui T et al (2011) Efficacy of selective α1 A adrenoceptor antagonist silodosin in the medical expulsive therapy for ureteral stones. Int J Urol 18:672–674PubMedGoogle Scholar
  14. 14.
    Rathi S, Agarwal A, Patnaik P et al (2014) Evaluation of medical expulsive therapy for distal ureteral stone: a prospective randomized controlled study to compare silodosin versus tamsulosin. Indian J Urol 30:S83–S84Google Scholar
  15. 15.
    Kumar S, Jayant K, Aqrawal MM et al (2015) Role of tamsulosin, tadalafil, and silodosin as the medical expulsive therapy in lower ureteric stone: a randomized trial (a pilot study). Urology 85:59–63CrossRefPubMedGoogle Scholar
  16. 16.
    Gupta S, Lodh B, Singh AK et al (2013) Comparing the efficacy of tamsulosin and silodosin in the medical expulsion therapy for ureteral calculi. J Clin Diagn 7:1672–1674Google Scholar
  17. 17.
    Dell’Atti L (2014) Silodosin versus Tamsulosin as medical expulsive therapy for distal ureteral stones: a prospective randomized study. Urologia. (Epub ahead of print)Google Scholar
  18. 18.
    Imperatore V, Di Meo S, Buonopane R et al (2012) Prospective randomized trial comparing the efficacy and safety of silodosin and tamsulosin as medical expulsive therapy for distal ureteric stones. J Endourol 26:A339–A340Google Scholar
  19. 19.
    Imperatore V, Fusco F, Creta M et al (2014) Medical expulsive therapy for distal ureteric stones: tamsulosin versus silodosin. Arch Ital Urol Androl 86:103–107CrossRefPubMedGoogle Scholar
  20. 20.
    Tsuzaka Y, Matsushima H, Kaneko T et al (2011) Naftopidil vs silodosin in medical expulsive therapy for ureteral stones: a randomized controlled study in Japanese male patients. Int J Urol 18(11):792–795CrossRefPubMedGoogle Scholar
  21. 21.
    Huang W, Xue P, Zong H, et al (2015) Efficacy and safety of silodosin in the medical expulsion therapy for distal ureteral calculi: a systematic review and meta-analysis. Br J Clin Pharmacol. (Epub ahead of print)Google Scholar
  22. 22.
    Cervenakov I, Fillo J, Mardiak J et al (2002) Speedy elimination of ureterolithiasis in lower part of ureters with the alpha 1- blocker-tamsulosin. Int Urol Nephrol 34:25–29CrossRefPubMedGoogle Scholar
  23. 23.
    Parsons JK, Hergan LA, Sakamoto K et al (2007) Efficacy of alpha blockers for the treatment of ureteral stones. J Urol 177:983–987CrossRefPubMedGoogle Scholar
  24. 24.
    Management of ureteral calculi:EAU/AUA nephrolithiasis panel (2007). American Urological Association Web site. ureteral-calculi.cfm. Accessed Journary 29,2014
  25. 25.
    Malin JM Jr, Deane RF, Boyarsky S (1970) Characterisation of adrenergic receptors in human ureter. Br J Urol 42:171–174CrossRefPubMedGoogle Scholar
  26. 26.
    Itoh Y, Kojima Y, Yasui T et al (2007) Examination of alpha 1 adrenoceptor subtypes in the human ureter. Int J Urol 14:749–753CrossRefPubMedGoogle Scholar
  27. 27.
    Tasian GE, Cost NG, Granberg CF et al (2014) Tamsulosin and spontaneous passage of ureteral stones in children: a multi-institutional cohort study. J Urol 192:506–511CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Sasaki S, Tomiyama Y, Kobayashi S, et al (2011) Characterization of α(1)-adrenoceptor subtypes mediating contraction in human isolated ureters. Urology. 77(3):762 e13–17Google Scholar
  29. 29.
    Lee SW, Woo SH, Yoo DS et al (2014) Effect of tamsulosin on stone expulsion in proximal ureteral calculi: an open-label randomized controlled trial. Int J Clin Pract 68(2):216–221CrossRefPubMedGoogle Scholar
  30. 30.
    Bozkurt O, Demir O, Sen V, et al (2015) Silodosin causes impaired ejaculation and enlargement of seminal vesicles in sexually active men treated for lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Urology. (Epub ahead of print)Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Xin-Jian Liu
    • 1
  • Jian-Guo Wen
    • 1
  • You-Dong Wan
    • 2
  • Bo-Wen Hu
    • 3
  • Qing-Wei Wang
    • 1
  • Yan Wang
    • 1
  1. 1.Department of Urodynamic Centre and UrologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
  2. 2.Department of Integrated Intensive Care UnitThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
  3. 3.Department of Hepatobiliary and Pancreatic SurgeryThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina

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