The efficacy and safety of adrenergic alpha-antagonists combined with PDE5 inhibitors in the medical expulsive therapy for unilateral distal ureteral stones: a systematic review and meta-analysis
Abstract
Background: Distal ureteral stones are a common urological condition, causing significant morbidity. While medical expulsive therapy (MET) using α-adrenergic receptor antagonists (α-ARAs) or phosphodiesterase-5 (PDE5) inhibitors has been widely studied, the efficacy and safety of their combination remain debated. This study aimed to evaluate the efficacy and safety of this combination therapy compared with α-ARAs alone.
Methods: A systematic search was conducted on PubMed, Embase, the Cochrane Library, Web of Science, and Chinese databases to identify clinical studies published up to November 02, 2025, involving patients with distal ureteral stones treated with PDE5 inhibitors in combination with α-ARAs.All analyses were performed using the Cochrane Collaboration Review Manager software (RevMan 5.4).
Results: A total of eight randomized controlled trials (RCTs) involving 1,202 patients were included, with 1,029 patients ultimately enrolled in the meta-analysis. For distal ureteral stones, the stone expulsion rate (SER) was significantly higher in the combination therapy group than in the α-ARA monotherapy group [risk ratio (RR) =1.25, P<0.001]. The mean stone expulsion time was also significantly shorter in the combination group [standardized mean difference (SMD) =-0.73, P<0.001]. In terms of pain episodes, combination therapy showed a trend toward reducing the number of pain attacks and the need for analgesics. However, the pooled analysis for pain episodes was limited by…
How strong is the evidence?
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. Reported size: 1,202 participants or records.
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