Efficacy and safety comparison between silodosin and tamsulosin as medical expulsive therapy for distal ureteral stones
DOI:
https://doi.org/10.13181/mji.oa.247180Keywords:
silodosin, tamsulosin, ureterolithiasisAbstract
BACKGROUND Ureteral stones are a common urological condition causing significant discomfort and morbidity. Medical expulsive therapy (MET) is a noninvasive approach to facilitate the passage of stones. This study aimed to compare the efficacy and safety of silodosin and tamsulosin as MET in patients with distal ureteral stones (DUS).
METHODS We searched CINAHL, Cochrane Library, PubMed, and ScienceDirect for randomized controlled trials (RCTs) on the administration of silodosin and tamsulosin for DUS. The primary outcomes analyzed were stone expulsion rates and expulsion times, measured as risk ratio (RR) and mean difference (MD), respectively. Statistical analyses were performed using Review Manager 5.4 and STATA 17.
RESULTS 14 RCTs comprising 1,535 patients (770 received silodosin) met the inclusion criteria. The silodosin group had notably higher stone expulsion rates (RR 1.20, 95% confidence interval [CI] 1.13–1.27, p<0.00001, I² = 37%), shorter expulsion times (MD −2.98, 95% CI −4.35–−1.62, p<0.01, I² = 85%), and fewer colicky pain episodes (MD −0.35, 95% CI −0.59–−0.10, p<0.01, I² = 83%) than the tamsulosin group. Retrograde ejaculation was the only adverse event that had a significant difference between both groups, statistically favoring tamsulosin (RR 1.61, 95% CI 1.12–2.33, p = 0.01, I² = 0%).
CONCLUSIONS Silodosin should be preferred as the first-line MET agent for DUS owing to its better expulsion rate, shorter stone expulsion time, and fewer colicky pain episodes. However, tamsulosin may be used in selected cases where patients experience retrograde ejaculation after receiving silodosin.
Downloads
References
Liu Y, Chen Y, Liao B, Luo D, Wang K, Li H, et al. Epidemiology of urolithiasis in Asia. Asian J Urol. 2018;5(4):205-14. https://doi.org/10.1016/j.ajur.2018.08.007
Afsar B, Kiremit MC, Sag AA, Tarim K, Acar O, Esen T, et al. The role of sodium intake in nephrolithiasis: epidemiology, pathogenesis, and future directions. Eur J Intern Med. 2016;35:16-9. https://doi.org/10.1016/j.ejim.2016.07.001
Gottlieb M, Long B, Koyfman A. The evaluation and management of urolithiasis in the ED: a review of the literature. Am J Emerg Med. 2018;36(4):699-706. https://doi.org/10.1016/j.ajem.2018.01.003
Edvardsson VO, Indridason OS, Haraldsson G, Kjartansson O, Palsson R. Temporal trends in the incidence of kidney stone disease. Kidney Int. 2013;83(1):146-52. https://doi.org/10.1038/ki.2012.320
Pal DK, Kumar A, Sarkar D. A comparative study of the efficacy of silodosin versus tamsulosin versus oral hydration therapy in medical expulsion therapy for ureteral calculi. Urol Sci. 2022;33(1):19-25. https://doi.org/10.4103/UROS.UROS_16_21
Jendeberg J, Geijer H, Alshamari M, Cierzniak B, Lidén M. Size matters: the width and location of a ureteral stone accurately predict the chance of spontaneous passage. Eur Radiol. 2017;27(11):4775-85. https://doi.org/10.1007/s00330-017-4852-6
Bos D, Kapoor A. Update on medical expulsive therapy for distal ureteral stones: beyond alpha-blockers. Can Urol Assoc J. 2014;8(11-2):442-5. https://doi.org/10.5489/cuaj.2472
Campschroer T, Zhu X, Vernooij RW, Lock MT. Alpha-blockers as medical expulsive therapy for ureteral stones. Cochrane Database Syst Rev. 2018;4(4):CD008509. https://doi.org/10.1002/14651858.CD008509.pub3
EAU Guidelines. Edn. presented at the EAU Annual Congress Milan 2023. ISBN 978-94-92671-19-6. Arnhem: EAU Guidelines Office; 2023.
Sharma G, Kaundal P, Pareek T, Tyagi S, Sharma AP, Devana SK, et al. Comparison of efficacy of various drugs used for medical expulsive therapy for distal ureter stones: a systematic review and network meta-analysis. Int J Clin Pract. 2021;75(9):e14214. https://doi.org/10.1111/ijcp.14214
Elgalaly H, Sakr A, Fawzi A, Salem EA, Desoky E, Shahin A, et al. Silodosin vs tamsulosin in the management of distal ureteric stones: a prospective randomised study. Arab J Urol. 2016;14(1):12-7. https://doi.org/10.1016/j.aju.2015.11.004
AS A, Pillai SR, Mary A, Aravindakshan R. Efficacy of tamsulosin and silodosin as medical expulsive therapy in the management of distal ureteral stones: a randomized controlled study. Int Surg J. 2016;3(2):578-81. https://doi.org/10.18203/2349-2902.isj20161125
Antony A, G J, Ali NI. Comparative efficacy of silodosin vs tamsulosin for ureteric calculus: a single centre double blind randomised controlled trial. J Med Sci Clin Res. 2017;5(12):31928-32. https://doi.org/10.18535/jmscr/v5i12.106
Dell'Atti L. Silodosin versus tamsulosin as medical expulsive therapy for distal ureteral stones: a prospective randomized study. Urologia. 2015;82(1):54-7. https://doi.org/10.5301/uro.5000083
Georgescu D, Ioni??-Radu F, Mul?escu R, Dragu?escu M, Geavlete B, Geavlete P, et al. The role of a1-blockers in the medical expulsive therapy for ureteral calculi - a prospective controlled randomized study comparing tamsulosin and silodosin. Farmacia. 2015;63(2):184-8.
Gharib T, Mohey A, Fathi A, Alhefnawy M, Alazaby H, Eldakhakhny A. Comparative study between silodosin and tamsulosin in expectant therapy of distal ureteral stones. Urol Int. 2018;101(2):161-6. https://doi.org/10.1159/000490623
Gupta S, Lodh B, Singh AK, Somarendra K, Meitei KS, Singh SR. Comparing the efficacy of tamsulosin and silodosin in the medical expulsion therapy for ureteral calculi. J Clin Diagn Res. 2013;7(8):1672-4. https://doi.org/10.7860/JCDR/2013/6141.3241
Gur M, Ulu MB, Caliskan ST, Ozturk K, Akdeniz E. Dexketoprofen vs. tamsulosin vs. silodosin vs. tadalafil as medical expulsive therapy for distal ureteral stones in men. J Coll Physicians Surg Pak. 2021;31(8):947-52. https://doi.org/10.29271/jcpsp.2021.08.947
Kumar S, Jayant K, Agrawal MM, Singh SK, Agrawal S, Parmar KM. Role of tamsulosin, tadalafil, and silodosin as the medical expulsive therapy in lower ureteric stone: a randomized trial (a pilot study). Urology. 2015;85(1):59-63. https://doi.org/10.1016/j.urology.2014.09.022
Priyanka, Jadhav RR. Comparison between tamsulosin and silodosin in lower ureteric stone- a randomised controlled study. J Evolution Med Dent Sci. 2017;6(93):6766-9. https://doi.org/10.14260/jemds/2017/1465
Rahman MJ, Faridi MS, Mibang N, Singh RS. Comparing tamsulosin, silodosin versus silodosin plus tadalafil as medical expulsive therapy for lower ureteric stones: a randomised trial. Arab J Urol. 2017;16(2):245-9. https://doi.org/10.1016/j.aju.2017.11.012
Reddy S, Prathvi, Kulshreshtha M, Singh P. A prospective study comparing tamsulosin and silodosin in medical expulsive therapy for lower ureteric stones. J Evolution Med Dent Sci. 2016;5(59):4108-11. https://doi.org/10.14260/jemds/2016/939
Sharma G, Khadav B, Sadasukhi TC, Gupta M, Gupta HL. Comparative analysis of silodosin and tamsulosin in distal ureteric calculus treatment. J Evid Based Med Healthc. 2016;3(85):4647-9. https://doi.org/10.18410/jebmh/2016/979
Soliman MG, El-Gamal O, El-Gamal S, Abdel Raheem A, Abou-Ramadan A, El-Abd A. Silodosin versus tamsulosin as medical expulsive therapy for children with lower-third ureteric stones: prospective randomized placebo-controlled study. Urol Int. 2021;105(7-8):568-73. https://doi.org/10.1159/000513074
Samir M, Awad AF, Maged WA. Does mirabegron have a potential role as a medical expulsive therapy in the treatment of distal ureteral stones? A prospective randomized controlled study. Urologia. 2023:3915603231204081. https://doi.org/10.1177/03915603231204081
Ibrahim AK, Mahmood IH, Mahmood NS. Efficacy and safety of tamsulosin vs. alfuzosin as medical expulsive therapy for ureteric stones. Arab J Urol. 2013;11:142-7. https://doi.org/10.1016/j.aju.2013.02.003
Roehrborn CG, Cruz F, Fusco F. a1-blockers in men with lower urinary tract symptoms suggestive of benign prostatic obstruction: is silodosin different? Adv Ther. 2017;33(12):2110-21. https://doi.org/10.1007/s12325-016-0423-5
Yu ZJ, Yan HL, Xu FH, Chao HC, Deng LH, Xu XD, et al. Efficacy and side effects of drugs commonly used for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia. Front Pharmacol. 2020;11:658. https://doi.org/10.3389/fphar.2020.00658
Published
How to Cite
Issue
Section
License
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.
