SynthesisWorld journal of urology2025
Comparing Tamsulosin vs. Silodosin prior to Ureteroscopy: A Network Meta-Analysis of Randomized Controlled Trials.
Synthesis in World journal of urology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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7 authors.
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Abstract
purposePre-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.
methodsA 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).
results20 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.
conclusionsSilodosin 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.
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