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Purpose <p>Pre-operative alpha blockers (α-blockers) have demonstrated improved ureteral access during ureteroscopy (URS) in patients with urolithiasis, with Tamsulosin or Silodosin interchangeably administered. This network meta-analysis (NMA) of randomized controlled trials (RCTs) aims to compare pre-operative Tamsulosin, Silodosin, and placebo in-terms of successful stone-access rate (SAR). Secondary outcomes are stone-free rate (SFR), operative time, ureteral dilatation requirement, ureteral wall (UW) injury and overall complications.</p> Methods <p>A systematic review in-line with PRISMA guidelines was conducted, with multiple databases searched from inception till December 26,2024. Inclusion was restricted to published journal RCTs in English that compared each α-blocker to placebo in patients undergoing URS, measuring relevant outcomes. A frequentist NMA was conducted, using odds ratios (OR) for binary endpoints, and mean difference for continuous outcomes (MD).</p> Results <p>20 RCTs and 2377 patients (Silodosin(<i>n</i> = 443), Tamsulosin(<i>n</i> = 762), Control(<i>n</i> = 1172)) were included, with only 1 RCT directly comparing both drugs. Overall, no significant difference was found between Silodosin and Tamsulosin across primary nor secondary outcomes. Silodosin yielded higher SAR (OR = 1.77,95%CI[0.95,3.29], <i>P</i> &gt; 0.05) less need for ureteral dilatation (OR 0.72,95%CI[0.47,1.32], <i>P</i> &gt; 0.05), and less operative time (MD -3.80,95%CI[-16.17, 8.56], <i>P</i> &gt; 0.05) compared to Tamsulosin, although non-significant. No significant difference was found in SFR (<i>P</i> &gt; 0.05), overall complications and UW injury. Both α-blockers were significantly favored over control across all outcomes (<i>P</i> &lt; 0.05) except for operative time where Tamsulosin yielded no difference.</p> Conclusions <p>Silodosin and Tamsulosin are both viable options pre-URS, with Silodosin potentially yielding shorter operative time, less ureteral dilatation required and higher SAR. However, these differences are non-significant and stem from indirect estimates. Therefore, randomized head-to-head comparison trials are warranted.</p>

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Comparing Tamsulosin vs. Silodosin prior to Ureteroscopy: A Network Meta-Analysis of Randomized Controlled Trials

  • 期刊论文

  • 发表日期：

    2025年11月6日

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  • Mohammed Ramadhan,
  • Tarek Benzouak,
  • Yahya Ali,
  • Abdullah Almehandi,
  • Abdulrahman O. Al-Naseem,
  • Fadl Hamouche,
  • Ahmad Almarzouq

摘要

Purpose

Pre-operative alpha blockers (α-blockers) have demonstrated improved ureteral access during ureteroscopy (URS) in patients with urolithiasis, with Tamsulosin or Silodosin interchangeably administered. This network meta-analysis (NMA) of randomized controlled trials (RCTs) aims to compare pre-operative Tamsulosin, Silodosin, and placebo in-terms of successful stone-access rate (SAR). Secondary outcomes are stone-free rate (SFR), operative time, ureteral dilatation requirement, ureteral wall (UW) injury and overall complications.

Methods

A systematic review in-line with PRISMA guidelines was conducted, with multiple databases searched from inception till December 26,2024. Inclusion was restricted to published journal RCTs in English that compared each α-blocker to placebo in patients undergoing URS, measuring relevant outcomes. A frequentist NMA was conducted, using odds ratios (OR) for binary endpoints, and mean difference for continuous outcomes (MD).

Results

20 RCTs and 2377 patients (Silodosin(n = 443), Tamsulosin(n = 762), Control(n = 1172)) were included, with only 1 RCT directly comparing both drugs. Overall, no significant difference was found between Silodosin and Tamsulosin across primary nor secondary outcomes. Silodosin yielded higher SAR (OR = 1.77,95%CI[0.95,3.29], P > 0.05) less need for ureteral dilatation (OR 0.72,95%CI[0.47,1.32], P > 0.05), and less operative time (MD -3.80,95%CI[-16.17, 8.56], P > 0.05) compared to Tamsulosin, although non-significant. No significant difference was found in SFR (P > 0.05), overall complications and UW injury. Both α-blockers were significantly favored over control across all outcomes (P < 0.05) except for operative time where Tamsulosin yielded no difference.

Conclusions

Silodosin and Tamsulosin are both viable options pre-URS, with Silodosin potentially yielding shorter operative time, less ureteral dilatation required and higher SAR. However, these differences are non-significant and stem from indirect estimates. Therefore, randomized head-to-head comparison trials are warranted.