Published In
Urology Research and Practice
Volume 51 · Issue 5
Pages: 179-188
History
Published Online: December 5, 2025
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Murilo Ribeiro Sanches
Department of Medicine, Federal University of Goiás, Goiânia, Brazil
Lucas Guimarães Campos Roriz de Amorim
Department of Urology, Federal University of Minas Gerais, Belo Horizonte, Brazil
Marcus Vinícius Barbosa Moreira
Department of Medicine, Potiguar University, Natal, Brazil
Lucas Bresciani Padilha
Department of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
Lígia Sant’Ana Dumont
Department of Medicine, Evangelical University of Goiás, Anápolis, Brazil
Edoardo Pozzi
Department of Urology, University of Miami Miller School of Medicine, Miami, United States of America
Francesco Costantini Mesquita
Department of Urology, São José do Rio Preto School of Medicine (FAMERP/FUNFARME), São José do Rio Preto, São Paulo, Brazil
Lucas Ribeiro Campos
Department of Urology, Federal University of Minas Gerais, Belo Horizonte, Brazil
Marcelo Esteves Chaves Campos
Department of Urology, Federal University of Minas Gerais, Belo Horizonte, Brazil
Ranjith Ramasamy
Department of Urology, Jumeirah American Clinic, Dubai, UAE
Sanches, M. R., Campos Roriz de Amorim, L. G., Barbosa Moreira, M. V., Padilha, L. B., Dumont, L. S., Pozzi, E., … Ramasamy, R. (2025). Tadalafil Versus Tamsulosin or Silodosin as Medical Expulsive Therapy for Distal Ureteral Stones: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Urology Research and Practice, 51(5), 179–188. https://doi.org/10.5152/tud.2025.24145
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Abstract
Objective: Medical expulsive therapy (MET) facilitates the passage of distal ureteric stones. Alpha-blockers are the standard MET strategy. However, there has been grow ing interest in using tadalafil, a Phosphodiesterase type 5 (PDE5) inhibitor, to facilitate
ureteral stone passage. Therefore, a systematic review and meta-analysis comparing tadalafil versus tamsulosin or silodosin was conducted as MET options for patients with distal ureteral stones.
Methods: PubMed, Embase, and Cochrane Library were systematically searched in September 2023 for randomized controlled trials (RCTs) comparing tadalafil with alpha-blockers (tamsulosin or silodosin) for distal ureteric stones. Outcomes included stone expulsion rate (SER), stone expulsion time (SET), colic episodes, analgesic use, and side effects. Review Manager 5.4.1 was used for statistical analysis, applying a ran dom-effects model.
Results: Eleven RCTs were included with 1345 patients, 579 (43%) randomized to tadalafil. No significant differences were found between groups for SER (risk ratio [RR] 1.07; 95% CI 0.98-1.18; P = .14), SET (RR −0.68; 95% CI −1.75 to 0.38; P = .21), colic epi sodes, or analgesic use. Headaches were significantly less frequent with alpha-blockers (RR 1.50; 95% CI 1.09-2.04; P = .01), while abnormal ejaculation was significantly less frequent in the tadalafil group (RR 0.38; 95% CI 0.19-0.74; P = .005).
Conclusion: Given the comparable efficacy in stone expulsion and the distinct side effect profiles, the choice between tadalafil and alpha-blockers for MET can be individ ualized. Tadalafil emerges as a strong MET alternative, particularly when alpha-blockers are contraindicated or poorly tolerated.
Cite this article as: Sanches MR, Amorim LGCRd, Moreira MVB, et al. Tadalafil versus tamsulosin or silodosin as medical expulsive therapy for distal ureteral stones: A systematic review and meta-analysis of randomized controlled trials. Urol Res Pract. 2025;51(5):179-188.
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Article Info
Published In
Journal
Urology Research and Practice
Volume / Issue
Volume 51 · Issue 5
Pages
179-188
History
Published Online
December 5, 2025
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Affiliations
Murilo Ribeiro Sanches
Department of Medicine, Federal University of Goiás, Goiânia, Brazil
Lucas Guimarães Campos Roriz de Amorim
Department of Urology, Federal University of Minas Gerais, Belo Horizonte, Brazil
Marcus Vinícius Barbosa Moreira
Department of Medicine, Potiguar University, Natal, Brazil
Lucas Bresciani Padilha
Department of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
Lígia Sant’Ana Dumont
Department of Medicine, Evangelical University of Goiás, Anápolis, Brazil
Edoardo Pozzi
Department of Urology, University of Miami Miller School of Medicine, Miami, United States of America
Francesco Costantini Mesquita
Department of Urology, São José do Rio Preto School of Medicine (FAMERP/FUNFARME), São José do Rio Preto, São Paulo, Brazil
Lucas Ribeiro Campos
Department of Urology, Federal University of Minas Gerais, Belo Horizonte, Brazil
Marcelo Esteves Chaves Campos
Department of Urology, Federal University of Minas Gerais, Belo Horizonte, Brazil
Ranjith Ramasamy
Department of Urology, Jumeirah American Clinic, Dubai, UAE
Cite this Article
Sanches, M. R., Campos Roriz de Amorim, L. G., Barbosa Moreira, M. V., Padilha, L. B., Dumont, L. S., Pozzi, E., … Ramasamy, R. (2025). Tadalafil Versus Tamsulosin or Silodosin as Medical Expulsive Therapy for Distal Ureteral Stones: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Urology Research and Practice, 51(5), 179–188. https://doi.org/10.5152/tud.2025.24145
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