Efficacy of alpha-blockers in medical expulsive therapy for ureteral stones - A systematic review and meta-analysis of randomized controlled trials between 2010 and 2025

Sep 30, 2026

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Alpha-blockers are widely used in medical expulsive therapy (MET) for ureteral stones, yet comparative effectiveness across agents remains inconsistent. This systematic review and meta-analysis evaluated efficacy and safety by searching randomized controlled trials published from 2010 to 2025. Primary outcomes included stone expulsion rate, with secondary measures covering time to expulsion, pain, analgesic use, and adverse events. Network meta-analysis compared different alpha-blockers and subgroup analyses assessed determinants of outcomes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages14

Reading Time35 min

AccessFree to download

Abstract

Introduction

Methods

Results

Conclusion

Keywords

Article history

Introduction

Urolithiasis and management context

ARAB JOURNAL OF UROLOGY 2026, VOL. 24, NO. 1, 1–14 [https://doi.org/10.1080/20905998.2025.2532196](https://doi.org/10.1080/20905998.2025.2532196) |
Efficacy of alpha-blockers in medical expulsive therapy for ureteral stones: A systematic review and meta-analysis of randomized controlled trials between 2010 and 2025
Mohammed Marzouq Almaghthawi a, Eman Abdullah Alotaibi b, Mohammed Saad Alotaibi c, Renad Wesam Alomarid, Yazeed Dakhel Alsulamic, Manar Ali Alahamdie, Salem Ibrahim S Aljadduaf, Wijdan Ateeq Allah Alruhailig, Eyad Mohammed Hijazih, Abdullah Sulaiman Alkharbooshi,
Oroub Abdulaziz Almurshedj and Adel H. Alshammarik
aCollege of Medicine, Qassim University, Unayzah city, Al-Mulaida, Saudi Arabia; bDepartment of Family and Community Medicine, College of Medicine, Qassim University, Unayzah city, Al-Mulaida, Saudi Arabia; cCollege of Pharmacy, Umm Al-Qura University, Makkah AlMukarramah, Saudi Arabia; dCollege of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; eCollege of Pharmacy, Taibah University, Al Madinah Al Munawwarah, Saudi Arabia; fCollege of Medicine, Jouf University, Al-Jouf, Saudi Arabia; gCollege of Medicine, Taibah University, Al Madinah Al Munawwarah, Saudi Arabia; hCollege of Medicine, Alfaisal University, Riyadh, Saudi Arabia; iCollege of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; jCollege of Medicine, Qassim University, Al-Qassim, Saudi Arabia; kGeneral Practice, Hafar albatin Cluster, MCH, Hafar Alnatin, Saudi Arabia | | | | --- | --- | --- | | ABSTRACT
Introduction: Alpha-blockers are widely used in medical expulsive therapy (MET) for ureteral stones; however, the current evidence regarding their comparative effectiveness remains inconsistent. We aimed to evaluate the efficacy and safety of different alpha-blockers in facilitating ureteral stone passage and identify factors influencing treatment outcomes. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) published between 2010 and 2025. We searched multiple databases for studies comparing alpha-blockers with control interventions or other alpha-blockers for ureteral stones ≤10 mm. Primary outcome was stone expulsion rate; secondary outcomes included time to expulsion, pain episodes, analgesic use, and adverse events. We performed subgroup analyses by alpha-blocker type, stone size, location, and treatment duration. Network meta-analysis assessed comparative effectiveness between agents.
Results: Twenty-nine RCTs with a total of 4,256 patients were included. Alpha-blockers significantly increased stone expulsion rates compared to controls (70.9% vs. 56.5%; RR 1.25, 95% CI 1.20–1.32; Number Needed to Treat (NNT) = 7) and reduced expulsion time by approximately three-days. Efficacy was greatest for distal ureteral stones (RR 1.52; Number Needed to Treat (NNT) = 4) and stones 5–10 mm (RR 1.35; NNT = 6) . Network meta-analysis revealed efficacy ranking favoring at first terazosin, followed by doxazosin then, silodosin then, tamsulosin then, alfuzosin and last the least effective was naftopidil. Alpha-blockers significantly reduced pain episodes and analgesic requirements. Adverse events were infrequent (Number Needed to Harm (NNH) = 38), with retrograde ejaculation being most common with silodosin. Conclusion: Alpha-blockers significantly improve the stone expulsion rates and reduce expulsion time, especially for distal ureteral stones 5–10 mm in size. While tamsulosin remains the most studied agent, our network meta-analysis suggests terazosin and doxazosin may offer superior efficacy. The favorable risk-benefit profile supports routine use of alpha-blockers for appropriately selected patients with ureteral stones. | | ARTICLE HISTORY
Received 1 May 2025 Accepted 5 July 2025
KEYWORDS
Alpha-blockers; ureteral stones; urolithiasis; medical expulsive therapy; terazosin | | Introduction | espe

FAQs

What was the primary outcome in the systematic review?

The primary outcome was stone expulsion rate.

How many randomized controlled trials and patients were included?

Twenty-nine RCTs with a total of 4,256 patients were included.

Which alpha-blockers ranked highest in comparative efficacy?

The network meta-analysis ranked efficacy favoring terazosin first, followed by doxazosin, then silodosin, tamsulosin, alfuzosin, and least effective naftopidil.

Sep 30, 2026

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