The following is a summary of “Which combination of medical expulsive therapy is more effective for treatment of distal ureteral stone in adults? A systematic review and network meta-analysis,” published in the January 2025 issue of Urology by Taheri et al. 

Medical Expulsive Therapy (MET) is an established treatment for distal ureteral stones, offering effective stone clearance, pain control, and high patient satisfaction. It has lower morbidity compared to other urologic interventions. 

Researchers conducted a prospective study using network meta-analysis (NMA) to assess the effectiveness of combination medications in MET for distal ureteral stones.  

They conducted systematic searches in PubMed, Scopus, and Web of Science for relevant trials published between 2001 and 2024. Articles on MET for upper ureteral stones or post-shock wave lithotripsy (SWL) were excluded. NMA was performed to compare the effect of combination MET on stone expulsion rate (SER), stone expulsion time (SET), and need for analgesia. 

The results showed that combination MET of α-blockers with PDE-5 inhibitors (OR = 2.7, CI = 1.80–4.05), corticosteroids (OR = 2.7, CI = 1.81–4.13), and phytotherapy (OR = 3.10, CI = 1.62–5.92) was more effective than α-blockers alone in SER. Combining α-blockers with PDE-5 inhibitors (MD: -3.8, CI = -7.0, -0.5) showed significantly lower SET. Combination MET of α-blockers with PDE-5 inhibitors (MD: 1.0, CI = 0.4–1.7) and nifedipine with corticosteroids (MD: 1.2, CI = 0.4–1.9) significantly decreased analgesia use. 

Investigators found that combination MET with α-blockers, PDE-5 inhibitors, corticosteroids, and phytotherapy increased stone clearance by 2.7 to 3.1 times and reduced expulsion times and analgesia use, requiring further studies. 

Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-024-01679-2