Comparison of silodosin to tamsulosin for medical expulsive treatment of ureteral stones: a systematic review and meta-analysis (original) (raw)
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International Surgery Journal, 2016
Urolithiasis is a significant and worldwide health problem. Ureteral stones account for approximately 20% of urolithiasis cases. 70% of those cases are with location of stone in the distal 1/3 rd of ureter hence known as Distal Ureteral Stones (DUS) or Lower Ureteral Stones (LUS). Recently certain drugs have been used as supplement for observation in an effort to improve spontaneous stone expulsion. Tamsulosin and Silodosin are such selective alpha-blockers which act by relaxing the ureteral smooth muscles, richly innervated by alpha-adrenergic receptors. 1-4 Silodosin is a highly selective alpha 1A adrenoceptor blocker. Medical Expulsive Therapy (MET) is an excellent treatment modality in appropriately selected patients. Evidence suggests that MET can decrease colic events, narcotic usage and re-visits. MET also reduces unnecessary surgeries and associated risks thereby reducing cost of treatment. Despite the evidence, MET remains underutilized as a treatment modality. Factors influencing the spontaneous passage of ureteral stones are stone size, configuration, location, smooth muscle spasm, sub mucosal edema, and anatomy of lower ureter. We evaluated the efficacy of Tamsulosin and Silodosin as the medical treatment of symptomatic uncomplicated distal ABSTRACT Background: Alpha blockers are being commonly used as adjuvants in the medical management for the expulsion of ureteral stones. The present randomized study aims to evaluate the efficacy of Tamsulosin and Silodosin as medical therapy in the management of symptomatic distal ureteral stones. Methods: In this randomized control study the 120 patients enrolled were allotted to three groups. Patients in group 1 received tablet Tamsulosin 0.4 mg/day, group 2 received tablet Silodosin 8mg/day and group 3 served as the control group. Parameters noted were the blood pressure, stone position (% of expulsion in each group), adverse events noted and number of hospital visits. All patients were followed up weekly for a period of 28 days. Results: Study showed that both Tamsulosin (80% success) and Silodosin (85 %success rate) are equally efficacious when compared to the control group. Group 1 and Group 2 required less of pain killers and also had less frequent hospital admissions due to painful episodes as compared to the control group. Usual adverse reaction seen with alpha blockers like orthostatic hypotension and retrograde ejaculation were reported by some subjects in the test groups. Incidence of retrograde ejaculation was found to be more with the Silodosin group. Conclusions: Both the drugs appear to be effective in the medical management of distal ureteral stones. But Tamsulosin scores over Silodosin as it's well tolerated and with good stone expulsion rates.
Journal of Evolution of Medical and Dental Sciences, 2016
The urinary stone disease is one of the most common afflictions of the modern society and it has been described since antiquity with the westernization of global culture. The efficacy of mini-invasive therapies, such as Extracorporeal Shock Wave Lithotripsy [ESWL] and ureteroscopy are not risk free, are problematic and are quite expensive. Recently, the use of watchful waiting approach has been extended by using Pharmacotherapy. This can reduce symptoms and facilitate stone expulsion. MATERIALS AND METHODS This prospective randomised study was conducted between September 2015 and May 2016 at Rajarajeshwari Medical College and Hospital, Bangalore. The cohort comprised 100 adult patients (54 men and 46 women) who presented with a symptomatic, unilateral, single, uncomplicated lower ureteric stone of ≤ 10 mm. Patients were randomized into two equal groups, 50 (50%) patients received a daily single dose of tamsulosin 0.4 mg for 28 days and 50 (50%) patients received a daily single dose of silodosin 8 mg for 28 days. Both groups were compared in terms of patient's demographics, socioeconomic status, stone size and side, type of MET, stone expulsion rate, stone expulsion time, number of pain episodes, need for analgesics use and incidence of side effects. Subgroup analysis was performed according to stone size ≤ or > 5 mm.
Urologia Journal, 2014
Introduction The aim of this study was to compare the safety and efficacy of silodosin (8 mg) versus tamsulosin (0.4 mg) as a medical expulsive therapy for distal ureteral stones. Methods 136 patients (aged 18 years or older) had presented with renal colic, were diagnosed to have a single, unilateral, radiopaque, proximal ureteral stone (range 4–10 mm in size), and agreed to undergo conservative management. For a 3-week period, 68 patients per group were assigned to the following treatments: Group A (gA) received tamsulosin 0.4 mg once daily, and Group B (gB) received silodosin 8 mg once daily. The time to expulsion, analgesic use, follow-up, endoscopic treatment and adverse effects of drugs were noted. Results Considering all the patients enrolled (136), one patient in gA and two patients in gB were unable to continue the study because of orthostatic hypotension within a week from commencing the treatment. A total of 133 patients (gA: 67; gB: 66) were included in this study. A ston...
Urology, 2015
To evaluate the role of 2 different a-1 blockers and 1 phosphodiesterase-5 inhibitor as medical expulsive therapy for distal ureteric calculi. MATERIALS AND METHODS Between January 2011 and December 2012, 285 patients presenting with distal ureteric stones of size 5-10 mm were on consent randomly assigned to 1 of 3 outpatient treatment arms: tamsulosin (group A), silodosin (group B), and tadalafil (group C). Therapy was given for a maximum of 4 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of hospital visits for pain, follow-up, and endoscopic treatment and adverse effects of drugs were noted. All 3 groups were compared for normally distributed data by the analysis of variance, Bonferroni or Kruskal-Wallis test, and Mann-Whitney U test, as required. All the classified and categorical data were analyzed for all 3 groups by using the chi-square test. RESULTS There was a statistically significant expulsion rate of 83.3% in group B compared with 64.4% and 66.7% in groups A and C, respectively, with lower time of stone expulsion (P value ¼ .006 and P value ¼ .016, respectively). Statistically significant differences were noted in colicky episodes and analgesic requirement in group B than groups A and C. There was no serious adverse event. CONCLUSION Medical expulsive therapy for the distal ureteric stones using tamsulosin, silodosin, and tadalafil is safe, efficacious, and well tolerated. The result of this pilot study showed that silodosin increases ureteric stone expulsion quite significantly along with better control of pain with significantly lesser analgesic requirement. UROLOGY 85: 59e63, 2015.
Medical expulsive therapy for distal ureteric stones: tamsulosin versus silodosin
Archivio Italiano di Urologia e Andrologia, 2014
Objectives: To compare the efficacy and safety of tamsulosin and silodosin in the context of medical expulsive therapy (MET) of distal ureteric stones. Patients and methods: Observational data were collected retrospectively from patients who received silodosin (N = 50) or tamsulosin (N = 50) as MET from January 2012 to January 2013. Inclusion criteria were: patients aged ≥ 18 years with a single, unilateral, symptomatic, radiopaque ureteric stone of 10 mm or smaller in the largest dimension located between the lower border of the sacroiliac joint and the vesico-ureteric junction. Stone expulsion rate, stone expulsion time, number of pain episodes, need for analgesics use, incidence of side effects were compared. Results: Stone-expulsion rate in the silodosin and in the tamsulosin groups were 88% and 82%, respectively (p not significant). Mean expulsion times were 6.7 and 6.5 days in the silodosin and tamsulosin group, respectively (p not significant). Mean number of pain episodes we...
Silodosin vs tamsulosin in the management of distal ureteric stones: A prospective randomised study
Arab Journal of Urology, 2016
Objectives: To compare the efficacy of silodosin (8 mg) vs tamsulosin (0.4 mg), as a medical expulsive therapy, in the management of distal ureteric stones (DUS) in terms of stone clearance rate and stone expulsion time. Patients and methods: A prospective randomised study was conducted on 115 patients, aged 21-55 years, who had unilateral DUS of 610 mm. Patients were divided into two groups. Group 1 received silodosin (8 mg) and Group 2 received tamsulosin (0.4 mg) daily for 1 month. The patients were followed-up by ultrasonography, plain abdominal radiograph of the kidneys, ureters and bladder, and computed tomography (in some cases). Results: There was a significantly higher stone clearance rate of 83% in Group 1 vs 57% in Group 2 (P = 0.007). Group 1 also showed a significant advantage for stone expulsion time and analgesic use. Four patients, two in each group, discontinued the treatment in first few days due to side-effects (orthostatic hypotension). No severe complications were recorded during the treatment period. Retrograde ejaculation was recorded in nine and three patients in Groups 1 and 2, respectively. Conclusion: Our data show that silodosin is more effective than tamsulosin in the management of DUS for stone clearance rates and stone expulsion times. A multicentre study on larger scale is needed to confirm the efficacy and safety of silodosin.
International Journal of Pharmaceutical Sciences Review and Research
Introduction: If surgical intervention is not indicated, current international guidelines and evidences recommend medical expulsive therapy (MET) involving the administration of drugs to improve spontaneous stone passage. Medical expulsive therapy has now become an established modality of treatment, and employs the use of various drugs that act on the ureter with different mechanisms. It is hypothesised that elevation of cyclic guanosine monophosphate in ureteral smooth muscle by phosphodiesterase type 5 (PDE5) inhibitors may result in ureteral relaxation and increased stone clearance. Aims/ objective: To investigate whether we can achieve better ureteric relaxation and reduction in intramural pressure in order to facilitate stone passage by tamsulosin plus tadalafil combination therapy. Materials and Method: Stone expulsion rate of tamsulosin + tadalafil when compared to tamsulosin was our primary endpoint. (Assessed by subjective response and confirmed by repeat plain X ray abdome...
The Medical Journal of Cairo University, 2018
Background: Tamsulosin is an α-1A-specific blocker which induces selective relaxation of ureteral smooth muscle with subsequent inhibition of ureteral spasms and dilatation of the ureteral lumen and facilitates stone expulsion. Aim of the Study: In this prospective randomized study we aimed to assess the efficacy of use of alpha blocker (tamsulosin Hcl 0.4mg) on the outecome of ureteroscopic lithotripsy for distal ureteric stone. Patients and Methods: In a prospective study by a randomized controlled clinical trial, which was performed from September 2016 to March 2017, about 50 patients underwent ureteroscopic lithotripsy with the pneumatic wolf lithotripsy. The patients were randomly divided into 2 groups: The study group including 25 patients, received tamsulosin with our traditional treatment (hydration and analgesic when required), and the control group with 25 patients who received placebo with traditional treatment. Patients prospectively will be evaluated for stone clearing rate by imaging at morning of URSL and at the end of 2 nd week including: (KUB and pelvi abdominal ultrasound)and they will be evaluated for number of colic episodes, analgesic consumption and post-operative complications (haematuria and UTI). Results: The results showed that tamsulosin treatment group had short time of the procedure, easy extraction of the stone fragments, had low expulsion time, low urinary tract symptoms, least analgesic needs and low adverse effects. Conclusions: Administration of α-1A-specific antagon istmade the procedure of short time, easy extraction of the stone fragments reduced analgesic dosage and colic episodes, rate of adverse effects after ureteroscopic lithotripsy of lower ureteral stones and decreased gravel expulsion time after URSL.
International braz j urol
Introduction: The efficacy of alpha-blockers as medical expulsive therapy (MET) is well established. However, it is not known which of the three most commonly used alphablockers (tamsulosin, alfuzosin and silodosin) is the most efficacious. With this study we aimed to assess the efficacy of the three commonly used alpha-blockers as MET for distal ureter stones. Materials and Methods: For this review, we searched multiple databases such as PubMed/Medline, Scopus, Embase, OviD SP, CINAHL, and web of science to identify all the relevant randomized studies comparing the efficacy of tamsulosin, alfuzosin, and silodosin. Preferred reporting items for systematic reviews for network meta-analysis (PRISMA-NMA) were followed while conducting this review and the study protocol was registered with PROSPERO (CRD42020175706). Results: In this review, 31 studies with 7077 patients were included. Compared to placebo all the treatment groups were more effective for both stone expulsion rate (SER) and stone expulsion time (SET). For both SER and SET, silodosin had the highest SUCRA (94.8 and 90.4) values followed by alfuzosin (58.8 and 64.9) and tamsulosin (46.2 and 44.5). The incidence of postural hypotension was similar with all the drugs, whereas, the incidence of retrograde ejaculation was significantly higher for silodosin. Overall confidence for each comparison group in this review ranged from "very low" to "moderate" according to the CINeMA approach. Conclusion: Among the three commonly used alpha-blockers silodosin is the most efficacious drug as MET for lower ureter stones followed by alfuzosin and tamsulosin.
Comparative Analysis of Silodosin and Tamsulosin in Distal Ureteric Calculus Treatment
Journal of Evidence Based Medicine and Healthcare, 2016
BACKGROUND The urinary stone disease is one of the most common afflictions of the modern society and it has been described since antiquity with the westernisation of global culture. It has led to a lot of distress physically, mentally and financially to the affected individuals. Mini-invasive techniques like ESWL and ureteroscopy have their own negative aspects with discomfort to the patient being the prime in it. Hence, a need for conservative management in the form of pharmacotherapy has arisen in the past years and here we are investigating the same. The aim of the study is to compare the efficacy of silodosin (8 mg) vs. tamsulosin (0.4 mg) both in terms of the stone expulsion rate and the time to stone expulsion. MATERIALS AND METHODS A study comprising of 120 patients between the age group of 18-50 years with sonography-proven unilateral, uncomplicated lower ureteric calculus was undertaken from January 2015 to November 2015. Exclusion criteria were calculus more than or equal to 1 cm. Patients were divided in 2 Groups; Group A received silodosin 8 mg once daily for a month while Group B received tamsulosin 0.4 mg once daily. The patients were followed up weekly or biweekly with imaging studies. The endpoint was the stone expulsion rate and time, the rate of the interventions and the side effects.