Evaluating the safety and effectiveness of α-blockers versus mirabegron for medical expulsive therapy in ureteral calculi: A Systematic review and meta-analysis.

Introduction And Aim: The main categories of drugs employed for medical expulsive therapy in patients with ureteral calculi (UC) are alpha-blockers (α-B) and beta-adrenoceptor agonists. This meta-analysis evaluated the safety and effectiveness of α-B versus mirabegron (MIR) in treating UC.

Methods: From January 1980 to October 2024, we extensively searched the Pubmed, Web of science, Cochrane and EMBASE databases to identify randomized controlled trials (RCTs) that compared the effectiveness of α-B and MIR in managing UC. Furthermore, a systematic review and meta-analysis were carried out.

Results: The meta-analysis included six publications with 592 patients, comparing α-B with MIR. The stone expulsion rate (SER) was found to be significantly greater in the α-B group than in the MIR group, as indicated by an odds ratio (OR) of 1.51 (95% confidence interval [CI]: 1.05 to 2.16, P = 0.03) in the meta-analysis. However, no significant differences were found between the α-B group and the MIR group for stone expulsion time (SET) (mean difference [MD]: 1.20; 95% CI, -2.71 to 5.10; P = 0.55), pain episodes (PE) (MD: 0.36; 95% CI, -0.04 to 0.76; P = 0.07), or analgesic requirements (MD: 0.79; 95% CI, -0.37 to 1.94; P = 0.18). The α-B group exhibited a significantly higher incidence of adverse events compared to the MIR group for orthostatic hypotension (OR 12.16, 95% CI 3.36 to 43.95, P = 0.0001), headache (OR 3.46, 95% CI 1.41 to 8.49, P = 0.007), and retrograde ejaculation (OR 16.30, 95% CI 5.87 to 45.31, P < 0.00001). While in the dizziness (OR 1.65, 95% CI 0.67 to 4.09, p = 0.28), it made no difference.

Conclusions: Our meta-analysis identified a substantial enhancement in the SER among patients with UC who received α-B therapy instead of those who were administered MIR therapy. Nonetheless, α-B therapy was connected to an increased risk of adverse events.

Systematic Review Registration: PROSPERO, ID CRD42024595934.