title: Efficacy of phosphodiesterase type 5 inhibitors for the treatment of distal ureteral calculi: A systematic review and meta-analysis.
abstract: To determine the efficacy of phosphodiesterase type 5 inhibitors (PDE5i) as medical expulsive therapy (MET) for the treatment of distal ureteral calculi.
  
  
  
  A search strategy was conducted in the MEDLINE, CENTRAL, and Embase databases. Searches were also conducted in other databases and unpublished literature. Clinical trials were included without language restrictions. The risk of bias was evaluated with the Cochrane Collaboration's tool. An analysis of random effects due to statistical heterogeneity was conducted. The primary outcome was the expulsion rate of the distal ureteral calculus in 28 days. The secondary outcomes were the time to expulsion, side effects of treatment, and amount (mg) of nonopioid analgesia. The measure of the effect was the risk difference (RD) with a 95% confidence interval (CI). The planned interventions were PDE5i vs. placebo, tadalafil vs. placebo, and tadalafil vs. tamsulosin.
  
  
  
  Four articles were included in the qualitative and quantitative analysis. Records of 580 patients were found among the four studies. A low risk of bias was shown for the majority of the study items. The calculi expulsion rate had an RD of 0.26 (95% CI, 0.15-0.37) and a less prolonged expulsion as a secondary outcome with a mean difference of -4.39 days (95% CI, -6.69 to -2.09) in favor of PDE5i compared with the placebo. No significant difference was found for these outcomes when comparing tadalafil with tamsulosin.
  
  
  
  Compared with a placebo, PDE5i could be effective as MET for the treatment of distal ureter calculi.
authors.affiliation: Department of Urology, Universidad del Valle, Cali, Colombia.
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Montes Cardona
authors.affiliation: Department of Urology, Universidad del Valle, Cali, Colombia.
authors.forename: Herney Andrés
authors.initials: HA
authors.lastname: García-Perdomo
mesh_terms: D000698:Analgesia / Q000379:methods; D006801:Humans; D058986:Phosphodiesterase 5 Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D013449:Sulfonamides / Q000627:therapeutic use; D000068581:Tadalafil / Q000627:therapeutic use; D000077409:Tamsulosin; D014514:Ureteral Calculi / Q000188:drug therapy*; D064804:Urological Agents / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D058986:Phosphodiesterase 5 Inhibitors; D013449:Sulfonamides; D064804:Urological Agents; D000068581:Tadalafil; D000077409:Tamsulosin
keywords: Meta-analysis; Phosphodiesterase 5 inhibitors; Review; Ureteral calculi