Efficacy and safety of alpha blockers in medical expulsive therapy for ureteral stones: a mixed treatment network meta-analysis and trial sequential analysis of randomized controlled clinical trials

Introduction: Alpha blockers (AB) are the main group of drugs used for medical expulsive therapy (MET) in patients with ureteral stones. However, there is no consensus on the relative efficacy and safety of individual AB in MET. Areas covered: The present work is a network meta-analysis of randomized controlled trials comparing AB with either placebo or standard of care in patients with ureteral stones. Electronic databases of Medline, Cochrane CENTRAL and Google Scholar were searched for eligible clinical studies. Inverse variance heterogeneity model was used for mixed treatment comparisons. Stone expulsion rate (SER) and stone expulsion time (SET) were the primary outcomes. Sub-group analyses for the following subgroups were carried out: children; after shockwave lithotripsy; stone size of <= 5 mm; > 5 mm; proximal and distal ureteral stones. Expert review: AB, phosphodiesterase inhibitors and combined AB with corticosteroids were observed with significant stone expulsion rate compared to control group in a recent network meta-analysis. Due to lack of head-to-head clinical trials within AB, only tamsulosin has been widely recommended by various urological guidelines. The results of this network meta-analysis will guide the future researchers in evaluating other promising ABs as agents for MET.