藥物結石排除治療(MET)之常見藥物對於遠端輸尿管結石排出率比較：

統合分析及系統性文獻回顧

黃品叡¹、周芷伃²、鄭如惠³、蔡蔓綺⁴、吳紘岳¹

¹李綜合醫療社團法人大甲李綜合醫院 外科部 泌尿外科

²李綜合醫療社團法人大甲李綜合醫院 護理部

³李綜合醫療社團法人苑裡李綜合醫院 護理部

⁴疾病管制署中區管制中心 檢疫科

Comparison of expulsive rate of distal ureteral stone throughout medical expulsive therapy (MET) : A Meta-Analysis and Systematic Review

Pin-Jui Huang¹, Chih-Yu Chou², Ru-Hui Cheng³, Man-Chi Tsai⁴, Hung-Yueh Wu¹

¹Division of Urology, Department of Surgery, Dajia Lee Hospital

²Nursing Department, Dajia Lee Hospital

³Nursing Department, Yuanli Lee Hospital

⁴Quarantine Department, Central Regional Center, Centers for Disease Control, Ministry of Health and Welfare

Introduction:

Ureteral stones are a common condition in urology, and medical expulsive therapy (MET) is widely used worldwide for treating distal ureteral stones. Drugs such as Tamsulosin, Silodosin, and Tadalafil are commonly employed in MET for distal ureteral stone expulsion. This study aims to compare the stone clearance rates of Tamsulosin, Silodosin, and Tadalafil for distal ureteral stones, providing insight into clinical treatment options.

Materials and Methods:

A comprehensive search of databases including PubMed, the Cochrane Library, and the Airiti Library was conducted for retrospective studies up to October 2024 that assessed the use of Tamsulosin, Silodosin, or Tadalafil for distal ureteral stones. Studies lacking data on medical expulsive therapy were excluded. The primary measure was the stone-free rate. Pooled relative risks with 95% confidence intervals were calculated for each outcome using Review Manager (version 5.4) for meta-analysis.

Results:

Three randomized controlled trails including a total of 563 patients were identified for qualitative synthesis. In Group I (Tamsulosin vs. Silodosin), Tamsulosin showed a higher stone-free rate (Risk Ratio 0.91, 95% CI 0.78 to 1.07; p = 0.26; I² = 44%). In Group II (Tamsulosin vs. Silodosin), Tamsulosin showed a higher stone-free rate (Risk Ratio 0.88, 95% CI 0.76 to 1.01; p = 0.08; I² = 45%). In Group III (Tadalafil vs. Silodosin), Tadalafil showed a slightly higher stone-free rate (Risk Ratio 0.97, 95% CI 0.76 to 1.22; p = 0.78; I² = 79%). Unfortunately, the analysis of the three groups did not reach statistical significance.

Conclusion:

For distal ureteral stones with obstructive uropathy, Tamsulosin and Tadalafil both provide a higher stone-free rate compared to Silodosin. Tamsulosin appears to have a slightly better stone-free rate than Tadalafil. However, the results lack evidence of a statistically significant difference. Further high-quality studies with qualitative synthesis are recommended.