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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 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\n[https://doi.org/10.1080/20905998.2025.2532196](https://doi.org/10.1080/20905998.2025.2532196)  \n| \u003Cbr>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\u003Cbr>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,\u003Cbr>Oroub Abdulaziz Almurshedj and Adel H. Alshammarik\u003Cbr>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 |  |  |\n| --- | --- | --- |\n| ABSTRACT\u003Cbr>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.\u003Cbr>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\u003Cbr>Received 1 May 2025 Accepted 5 July 2025\u003Cbr>KEYWORDS\u003Cbr>Alpha-blockers; ureteral stones; urolithiasis; medical expulsive therapy; terazosin |\n| Introduction | espe","cbCaidEuUzlkHY2E","https://ap.wps.com/l/cbCaidEuUzlkHY2E","pdf",9160706,14,"English","# Abstract\n## Introduction\n## Methods\n## Results\n## Conclusion\n# Keywords\n# Article history\n# Introduction\n## Urolithiasis and management context","[{\"question\":\"What was the primary outcome in the systematic review?\",\"answer\":\"The primary outcome was stone expulsion rate.\"},{\"question\":\"How many randomized controlled trials and patients were included?\",\"answer\":\"Twenty-nine RCTs with a total of 4,256 patients were included.\"},{\"question\":\"Which alpha-blockers ranked highest in comparative efficacy?\",\"answer\":\"The network meta-analysis ranked efficacy favoring terazosin first, followed by doxazosin, then silodosin, tamsulosin, alfuzosin, and least effective naftopidil.\"}]","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 | PDF",1790741795,35]