Role of silodosin as medical expulsive therapy in ureteral calculi: a meta-analysis of randomized controlled trials
- 319 Downloads
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.
KeywordsSilodosin 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.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 4.Tiselius HG, Ackermann D, Alken P, et al. Guidelines on urolithiasis. European Association of Urology Web site. http://www.uroweb.org/fileadmin/user_upload/Guidelins/Urolithiasis.pdf. Accessed January 28, 2014
- 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
- 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
- 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.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.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
- 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
- 24.Management of ureteral calculi:EAU/AUA nephrolithiasis panel (2007). American Urological Association Web site. http://www.auanet.org/education/guidelines/ ureteral-calculi.cfm. Accessed Journary 29,2014
- 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
- 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