第五型磷酸二酯酶抑制劑在遠端輸尿管結石治療中的應用：文獻回顧與治療建議

徐政文¹、朱宏霖¹、梁哲維¹、徐慧燕²、廖沛瑀³、鄭如惠⁴、蔡蔓綺⁵、黃品叡⁶

1李綜合醫療社團法人大甲李綜合醫院 醫療部 專科護理師小組

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 醫療部 專科護理師小組

4李綜合醫療社團法人苑裡李綜合醫院 護理部

5疾病管制署中區管制中心 檢疫科

6李綜合醫療社團法人大甲李綜合醫院 外科部 泌尿外科

Phosphodiesterase Type 5 Inhibitors in the Management of Distal Ureteral Stones: A Literature Review and Therapeutic Recommendations

Cheng-Wen Hsu¹, Hung-Lin Chu¹, Che-Wei Liang¹,  Hui-Yen Hsu², Pei-Yu Liao³ , Ru-Hui Cheng⁴,
Man-Chi Tsai⁵, Pin-Jui Huang⁶

1Division of Nursing Participants, Department of Medical Affairs, Dajia Lee Hospital

2Nursing Department, Dajia Lee Hospital

3Division of Nursing Participants, Department of Medical Affairs, Yuanli Lee Hospital

4Nursing Department, Yuanli Lee Hospital

5Quarantine Department, Central Regional Center, Centers for Disease Control, Ministry of Health and Welfare

6Division of Urology, Department of Surgery, Dajia Lee Hospital

Background:

Medical expulsive therapy (MET) has become an essential component in the management of distal ureteral stones, aiming to enhance spontaneous passage and reduce the need for surgical intervention. Traditionally, alpha-blockers such as tamsulosin have been the mainstay of MET. However, recent studies have explored the role of phosphodiesterase type 5 (PDE5) inhibitors—such as sildenafil and tadalafil—due to their smooth muscle–relaxing effects on the ureter and potential to improve stone expulsion rates. This review summarizes current evidence on the efficacy, mechanisms, and clinical recommendations for PDE5 inhibitors in distal ureteral stone management.

Methods:

A comprehensive literature search was conducted using PubMed, Embase, and Scopus databases for articles published between 2010 and 2025. Keywords included “PDE5 inhibitor,” “sildenafil,” “tadalafil,” “distal ureteral stone,” and “medical expulsive therapy.” Randomized controlled trials (RCTs), meta-analyses, and comparative studies evaluating stone expulsion rate, time to passage, analgesic requirement, and adverse effects were included. Data were analyzed qualitatively with attention to pharmacologic rationale and clinical outcomes.

Results:

Across multiple RCTs, PDE5 inhibitors significantly improved stone expulsion rates compared to placebo and demonstrated comparable or superior efficacy to alpha-blockers. Combination therapy with PDE5 inhibitors and tamsulosin yielded the highest expulsion rates (up to 85–90%) and shortened stone passage time by approximately 3–5 days. Mechanistically, PDE5 inhibition enhances cyclic guanosine monophosphate (cGMP)-mediated smooth muscle relaxation in the distal ureter, reducing peristaltic frequency and intraluminal pressure. Pain scores and analgesic requirements were consistently lower in patients receiving PDE5 inhibitors, with mild and transient adverse effects such as headache and flushing. Meta-analyses further confirmed that tadalafil 10 mg daily for up to 4 weeks was both safe and effective, particularly for stones ≤10 mm in the distal third of the ureter.

Discussion:

While PDE5 inhibitors were originally developed for erectile dysfunction, their role in urolithiasis management is biologically plausible and clinically supported. They may serve as an alternative or adjunct to alpha-blockers in MET, especially in patients with concomitant lower urinary tract symptoms or sexual dysfunction. However, optimal dosing, duration, and patient selection criteria remain under investigation. Cost-effectiveness analyses and long-term safety data are warranted to justify widespread use.

Conclusion:

PDE5 inhibitors represent a promising adjunct in the medical management of distal ureteral stones, offering improved expulsion rates, faster passage, and better pain control. Combination therapy with alpha-blockers appears synergistic. Future large-scale RCTs should refine treatment algorithms to integrate PDE5 inhibitors into routine MET protocols for distal ureteral calculi.