Efficacy and safety of silodosin in the medical expulsion therapy for distal ureteral calculi: a systematic review and meta-analysis

AimsUsing a selective -adrenoceptor blocker for medical expulsive therapy (MET) is an effective treatment approach widely used for ureteral stones. The aim of the review was to assess the efficacy and safety of silodosin in medical expulstion therapy compared with placebo and tamsulosin. MethodsA systematic search was performed in PubMed, Cochrane Library and Embase to identify randomized controlled trials that compared silodosin with a placebo or tamsulosin for ureteral calculi. ResultsEight publications involving a total of 1048 patients were used in the analysis, which compared silodosin with placebo and tamsulosin. We found that silodosin was effective in treating ureteral calculi in our meta-analysis and was superior to tamsulosin in its efficacy. The expulsion rate of all ureteral stones (OR1.59, 95% CI1.08, 2.36, P=0.02), the expulsion rate of distal ureteral stones (OR2.82, 95% CI1.70, 4.67, P<0.0001) and the expulsion time (days) of distal ureteral stones (standard mean difference (SMD)-4.71, 95% CI-6.60, -2.83, P<0.00001) indicated that silodosin was more effective than the placebo. Moreover, expulsion rate (OR2.54, 95% CI1.70, 3.78, P<0.00001), expulsion time (days) (SMD-2.64, 95% CI-3.64, -1.64, P<0.00001) and pain episodes (P<0.00001) indicated that silodosin was more effective than the tamsulosin. Even though silodosin had a significant increase in abnormal ejaculation compared with tamsulosin, no significant differences were observed for complications (OR1.00, 95% CI0.58, 1.74, P=1.00). ConclusionsThis meta-analysis indicated that silodosin was superior to placebo or tamsulosin in the efficacy for distal ureteral calculi with better control of pain. The safety profile of silodosin was similar to tamsulosin though retrograde ejaculation was worse for silodosin use. We conclude that silodosin might have potential as a MET for ureteral stones.