Silodosin effective medical expulsive therapy for patients with ureteral stones; study reveals

Medical expulsive therapy defines the medication used to facilitate ureteral stone passage before surgical intervention. The two classes of medication accepted ad MET are calcium channel blockers and alpha-blockers. Of these, alpha-blockers are the most frequently used option. Previous studies have proven the role of calcium channel antagonists, alpha-blockers, corticosteroids, and furosemide in assisting stones expulsion.

Several trials have also reported a pooled risk ratio of 1.54 for MET. A previous study has reported the rate of stone expulsion with silodosin at 82% and tamsulosin at 58%.[8] Among all the alpha-blockers, tamsulosin is most commonly used for MET, with a 19% improvement in the stone clearance rate for ureteral stones, especially in the distal ureter.[2] In 2015, Ding et al. suggested that tamsulosin does not alleviate ureteral colic.

The most commonly used medical expulsive therapy is tamsulosin. However, its use is associated with the limitation of its inability to alleviate ureteral colic. In this context, it becomes essential to develop MET that can decrease ureteral colic while maintaining a high stone clearance rate. Silodosin, an α1A adrenoceptor, has high selectivity and affinity for the distal ureter, which may reduce ureteral colic and enable stone expulsion for patients with distal ureteral stones.

Therefore, Johan Renaldo from Airlangga University in Indonesia and colleagues aimed to investigate the efficacy of silodosin as MET and its role in ureteral colic reduction in patients with distal ureteral stones.

The study was conducted according to the Cochrane Handbook for Systematic Reviews and Intervention, adhering to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The researchers performed a comprehensive literature search in several online databases up to July 2021 for randomized trials comparing silodosin with placebo for medical expulsive therapy.

The study revealed the following findings:

• The analysis included a total of six randomized controlled trials comprising 907 patients.
• The analysis revealed that the patients who received silodosin had significantly higher stone expulsion rates (odds ratio [OR] 3.33), substantially shorter stone expulsion time (mean difference −3.79), and lower analgesic use (OR 0.4) compared to the group receiving placebo.

"Silodosin showed significantly lower stone expulsion time, higher stone expulsion rate, and lower use of analgesics in patients with distal ureteral stones versus a placebo," the researchers concluded.

Reference:

The study, "Silodosin as a medical expulsive therapy for distal ureteral stones: A systematic review and meta-analysis," was published in the Indian Journal of Urology. DOI: 10.4103/iju.iju_115_22