ReviewInternational journal of clinical and experimental pathology2026
Tamsulosin versus placebo for medical expulsive therapy in ureteral calculi: a systematic review and meta-analysis of randomized controlled trials.
Review in International journal of clinical and experimental pathology, 2026. 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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6 authors.
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Abstract
Ureteral calculi are a common cause of emergency department visits worldwide. Although small stones often pass spontaneously, medical expulsive therapy is frequently used to facilitate stone clearance and reduce the need for surgical intervention. Tamsulosin, an α1-adrenergic receptor antagonist, is commonly prescribed for this purpose, but its efficacy compared with placebo remains uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials comparing tamsulosin with placebo in patients with ureteral calculi. A comprehensive search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials was performed from database inception through April 2025. The primary outcome was the stone expulsion rate, and secondary outcomes included time to expulsion and the incidence of adverse events. Pooled estimates were calculated as risk ratios or mean differences with 95 percent confidence intervals, using a random-effects model. A total of 42 randomized controlled trials involving 7,117 patients met the inclusion criteria. Compared with placebo, tamsulosin significantly increased the stone expulsion rate (risk ratio 1.42, 95 percent confidence interval 1.29 to 1.56, P < 0.001) and shortened the time to expulsion by an average of 3.04 days (95 percent confidence interval 2.28 to 3.81 days, P < 0.00001). The overall incidence of adverse events did not differ significantly between groups, although subgroup analysis indicated a lower risk of moderate to severe complications with tamsulosin (risk ratio 0.35, 95 percent confidence interval 0.22 to 0.98, P < 0.0001). Substantial heterogeneity was observed across outcomes. In conclusion, tamsulosin improves stone expulsion and reduces clearance time without increasing overall adverse events. However, given the considerable heterogeneity among studies, these findings should be interpreted with caution. Further high-quality, large-scale trials are needed to confirm the benefits of tamsulosin and to identify patient subgroups most likely to benefit from therapy.
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