Silodosin in treating men With BPH-associated lower urinary tract Symptoms: A systematic review and network meta-analysis
Abstract
OBJECTIVES
To compare the efficacy and safety of silodosin-a highly selective α₁A-adrenoceptor antagonist-with placebo, tamsulosin, naftopidil, and alfuzosin in men with benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS).
METHODS
We conducted a systematic review and network meta-analysis (NMA) of randomized controlled trials retrieved from EMBASE, PubMed, Cochrane Library, ScienceDirect, and Web of Science until February 2024. Studies were selected based on predefined PICOS criteria. Two reviewers independently extracted data and assessed risk of bias using the Cochrane RoB tool. A frequentist random-effects NMA was performed; heterogeneity was evaluated with I2 statistic, and publication bias was assessed using Egger's and Begg's tests. Treatment rankings were based on surface under the cumulative ranking (SUCRA) probabilities.
RESULTS
Twenty-five RCTs (n = 6,831) were included. NMA showed silodosin significantly improved voiding symptoms versus tamsulosin (MD = 0.52, 95% CI: 0.01-0.56) and total IPSS versus naftopidil (P < 0.001). Silodosin monotherapy ranked highest for symptom improvement (SUCRA: 93.3-97.5%). However, it was associated with higher overall adverse events versus tamsulosin (RR = 1.26, P < 0.001) and significantly increased risk of retrograde ejaculation versus placebo (RR = 24.94, P < 0.001). Combination therapy with tadalafil improved urinary flow (SUCRA = 56.7%).
CONCLUSION
Silodosin is highly effective for BPH-LUTS,…
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: 6,831 participants or records.
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