The Comparative Effectiveness of PDE5 Inhibitors and β3 Agonists Versus α-Blockers in Medical Expulsive Therapy for Distal Ureteric Stones: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Abstract
Urolithiasis is a common urinary tract disease. This systematic review and meta-analysis aim to evaluate the effectiveness of alpha-blockers compared to novel therapies. The objective of this systematic review and meta-analysis was to compare the efficacy and safety of emerging pharmacologic therapies, namely tadalafil and mirabegron, with traditional alpha-blockers, such as tamsulosin and silodosin, as medical expulsive therapies (METs) for distal ureteric stones measuring ≤10 or <5 mm. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines were implemented during the conduct of this systematic review. A systematic review and meta-analysis of randomized controlled trials was conducted involving adult patients with distal ureteric stones. A total of six studies have been included, and quality assessment has been performed individually. Subgroup analyses were made using forest plots and funnel plots to study the odds ratios (ORs), confidence intervals (CIs), and heterogeneity of the articles. The studies included patients treated with various agents (tamsulosin, silodosin, tadalafil, and mirabegron) for up to four weeks. The primary outcome was the expulsion rate of the stones. Secondary outcomes included stone expulsion time (SET), analgesic use, hospital visits, and adverse effects. For the stone expulsion rate (SER), in the mirabegron subgroup, an overall pooled OR of 0.98 (95% CI: 0.26-3.66) with high heterogeneity was obtained (I² = 79%, p…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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