Study characteristics
In this review a total of 50 RCT’s with 12382 patients were included6, 11, 15, 19, 22, 25-68. Multiple treatments across these studies were assessed for medical expulsion of lower ureteric stone (alfuzosin (AL), alfuzosin plus steroids (AL-S), naftopidil (NAF), naftopidil plus steroids (NAF-S), nifedipine (NIF), nifedipine plus steroids (NIF-S), sildenafil (SIL), silodosin (SILO), tadalafil (TAD), tamsulosin (TAM), tamsulosin plus steroids (TAM-S), tadalafi plus silodosin, (TADplusSILO), tadalafil plus tamsulosin (TADplusTAM), tadalafil plus tamsulosin plus steroids (TADplusTAM-S). Control group was variably defined across the studies some including placebo (16 studies), others including best medical management with adequate hydration, analgesics and anti-spasmodics. Control with no specific treatment group was found in 9 studies26, 33, 45, 46, 53, 58, 59, 65, 69, diclofenac was used as control in 5 studies6, 27, 47-49, study by Cervanakov28 used tramadol with Veral and diazepam and Sio et al used Aescin with diclofenac70. Duration of treatment was variable across the studies ranging from 10 days to 6 weeks. All the groups compared well for baseline characteristics such as age, sex and stone size. All the studies included patients with stone size less than 10 mm. (Table 1)
Network map for the two outcomes i.e. stone expulsion rate (SER) and stone expulsion time (SET) are provided in Figure 2. For SER mixed evidence was available for 27 comparisons whereas indirect evidence was available for 78 comparisons. Most common comparison studied for this outcome was TAM versus C with 21 studies followed by NIF vs. TAM (6 studies), ALvs.C (5 studies), AL vs. TAM (4 studies). Tamsulosin was the most commonly studied drug across the network for SER with representation in 34 studies whereas AL-S71, TADplusTAM42, TADplusTAM-S43, TADplusSILO15 and SIL11 were limited to single studies. For secondary outcome i.e. SET, data was available from 32 studies with 13 treatment groups AL, NAF-S, NIF, NAF, NIF-S SIL, SILO, TAD, TADplusSILO, TADplusTAM, TADplusTAM-S, TAM-S and TAM. Most common comparison across the studies was C vs. TAM (13 studies), followed by 3 comparisons for each AL vs. C, C vs. NAF, SILO vs. TAM and TAM vs. TAD.