Comparison of efficacy of various drugs used for medical expulsive
therapy for distal ureter stones: a systematic review and network
Aim: Medical expulsive therapy for ureteric stones incudes various drug
interventions. For lower ureteric stone which individual drug treatment
or combination is best as MET is not known. Aim of this study was to
compare efficacy of various drug treatments for distal ureter stones.
Methods: Systematic literature search was conducted to include all the
randomized study comparing various drug interventions for lower ureter
stones. Standard Preferred reporting Items for systematic review and
meta-analysis for network meta-analysis (PRISMA-NMA) were pursued.
RESULTS: In this review, 50 randomized studies with 12,382 patients were
included. For stone expulsion rate (SER), compared to placebo all the
treatment groups were more effective except nifedipine and sildenafil.
According to the SUCRA values obtained naftopidil plus steroid was the
highest rank and nifedipine lowest. For stone expulsion time (SET),
compared to placebo only tadalafil plus silodosin, nifedipineplus
steroid,alfuzosin,silodosin, tadalafil and tamsulosin were more
effective. SUCRA values were highest for tadalafil plus silodosin and
least for naftopidil plus steroid. From subgroup analysis with
individual drugs for SER, SUCRA values were highest for naftopidil
followed by silodosin and SET was highest for silodosin and least for
naftopidil. Conlcusion: For lower ureter stone, tadalafil plus silodosin
is the best combination and silodosin best individual drug considering
the SET and SER. Nifedipine as montherapy is no more effective than