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Comparison of efficacy of various drugs used for medical expulsive therapy for distal ureter stones: a systematic review and network meta-analysis.
  • +3
  • Gopal Sharma,
  • Pawan Kaundal,
  • Tarun Pareek,
  • Shantanu TyagiOrcid,
  • Aditya Sharma,
  • Sudheer Devana
Gopal Sharma
PGIMER
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Pawan Kaundal
PGIMER
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Tarun Pareek
PGIMER
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Shantanu Tyagi
Orcid
PGIMER
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Aditya Sharma
PGIMER
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Sudheer Devana
PGIMER
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Abstract

Aim: Medical expulsive therapy for ureteric stones incudes various drug interventions. For lower ureteric stone which individual drug treatment or combination is best as MET is not known. Aim of this study was to compare efficacy of various drug treatments for distal ureter stones. Methods: Systematic literature search was conducted to include all the randomized study comparing various drug interventions for lower ureter stones. Standard Preferred reporting Items for systematic review and meta-analysis for network meta-analysis (PRISMA-NMA) were pursued. RESULTS: In this review, 50 randomized studies with 12,382 patients were included. For stone expulsion rate (SER), compared to placebo all the treatment groups were more effective except nifedipine and sildenafil. According to the SUCRA values obtained naftopidil plus steroid was the highest rank and nifedipine lowest. For stone expulsion time (SET), compared to placebo only tadalafil plus silodosin, nifedipineplus steroid,alfuzosin,silodosin, tadalafil and tamsulosin were more effective. SUCRA values were highest for tadalafil plus silodosin and least for naftopidil plus steroid. From subgroup analysis with individual drugs for SER, SUCRA values were highest for naftopidil followed by silodosin and SET was highest for silodosin and least for naftopidil. Conlcusion: For lower ureter stone, tadalafil plus silodosin is the best combination and silodosin best individual drug considering the SET and SER. Nifedipine as montherapy is no more effective than control group.