title: Efficacy and safety of silodosin in the medical expulsion therapy for distal ureteral calculi: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Using a selective α-adrenoceptor blocker for medical expulsive therapy (MET) is an effective treatment approach widely used for ureteral stones. The aim of the review was to assess the efficacy and safety of silodosin in medical expulstion therapy compared with placebo and tamsulosin.
  
  
  METHODS
  A systematic search was performed in PubMed, Cochrane Library and Embase to identify randomized controlled trials that compared silodosin with a placebo or tamsulosin for ureteral calculi.
  
  
  RESULTS
  Eight publications involving a total of 1048 patients were used in the analysis, which compared silodosin with placebo and tamsulosin. We found that silodosin was effective in treating ureteral calculi in our meta-analysis and was superior to tamsulosin in its efficacy. The expulsion rate of all ureteral stones (OR 1.59, 95% CI 1.08, 2.36, P = 0.02), the expulsion rate of distal ureteral stones (OR 2.82, 95% CI 1.70, 4.67, P < 0.0001) and the expulsion time (days) of distal ureteral stones (standard mean difference (SMD) -4.71, 95% CI -6.60, -2.83, P < 0.00001) indicated that silodosin was more effective than the placebo. Moreover, expulsion rate (OR 2.54, 95% CI 1.70, 3.78, P < 0.00001), expulsion time (days) (SMD -2.64, 95% CI -3.64, -1.64, P < 0.00001) and pain episodes (P < 0.00001) indicated that silodosin was more effective than the tamsulosin. Even though silodosin had a significant increase in abnormal ejaculation compared with tamsulosin, no significant differences were observed for complications (OR 1.00, 95% CI 0.58, 1.74, P = 1.00).
  
  
  CONCLUSIONS
  This meta-analysis indicated that silodosin was superior to placebo or tamsulosin in the efficacy for distal ureteral calculi with better control of pain. The safety profile of silodosin was similar to tamsulosin though retrograde ejaculation was worse for silodosin use. We conclude that silodosin might have potential as a MET for ureteral stones.
authors.affiliation: Urology Department, Beijing Tian Tan Hospital, Capital Medical University, Neurourology Research Division, China National Clinical Research Center for Neurological Disease, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Huang
authors.affiliation: Urology Department, Beijing Tian Tan Hospital, Capital Medical University, Neurourology Research Division, China National Clinical Research Center for Neurological Disease, Beijing, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Xue
authors.affiliation: Urology Department, Beijing Tian Tan Hospital, Capital Medical University, Neurourology Research Division, China National Clinical Research Center for Neurological Disease, Beijing, China.
authors.forename: Huantao
authors.initials: H
authors.lastname: Zong
authors.affiliation: Urology Department, Beijing Tian Tan Hospital, Capital Medical University, Neurourology Research Division, China National Clinical Research Center for Neurological Disease, Beijing, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000627:therapeutic use*; D006801:Humans; D007211:Indoles / Q000009:adverse effects / Q000627:therapeutic use*; D013449:Sulfonamides / Q000627:therapeutic use; D000077409:Tamsulosin; D014514:Ureteral Calculi / Q000188:drug therapy*
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D007211:Indoles; D013449:Sulfonamides; C095285:silodosin; D000077409:Tamsulosin
keywords: medical expulsion therapy; silodosin; stone and randomized controlled trials; ureteral calculi; urolithiasis