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

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. 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. 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. 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.α受体阻滞剂（Alpha-blockers）广泛应用于输尿管结石的医疗排石疗法（medical expulsive therapy, MET），但目前关于其相对疗效的现有证据仍存在不一致之处。本研究旨在评估不同α受体阻滞剂在促进输尿管结石排出方面的疗效与安全性，并明确影响治疗结局的相关因素。我们对2010年至2025年间发表的随机对照试验（randomized controlled trials, RCTs）开展了系统评价与Meta分析：通过多个数据库检索针对直径≤10mm输尿管结石、对比α受体阻滞剂与对照干预措施或其他α受体阻滞剂疗效的研究；主要结局指标为结石排出率，次要结局指标包括排石时间、疼痛发作次数、镇痛药物使用情况及不良事件。我们依据α受体阻滞剂类型、结石大小、位置与治疗时长进行了亚组分析，并通过网络Meta分析评估各药物间的相对疗效。最终纳入29项随机对照试验，共计4256例患者。与对照组相比，α受体阻滞剂可显著提升结石排出率（70.9% vs 56.5%；相对危险度（Relative Risk, RR）=1.25，95%置信区间（Confidence Interval, CI）=1.20~1.32；需治疗人数（Number Needed to Treat, NNT）=7），并将排石时间缩短约3天。对于输尿管下段结石（RR=1.52，NNT=4）以及直径5~10mm的结石（RR=1.35，NNT=6），α受体阻滞剂的疗效最为显著。网络Meta分析显示，各药物的疗效排序依次为：特拉唑嗪（terazosin）最优，其次为多沙唑嗪（doxazosin）、西洛多辛（silodosin）、坦索罗辛（tamsulosin）、阿夫唑嗪（alfuzosin），疗效最差的为萘哌地尔（naftopidil）。α受体阻滞剂可显著减少疼痛发作次数与镇痛药物使用需求，不良事件发生率较低（需治疗伤害人数（Number Needed to Harm, NNH）=38），其中西洛多辛最常见的不良事件为逆行射精（retrograde ejaculation）。α受体阻滞剂可显著提升结石排出率并缩短排石时间，尤其适用于直径5~10mm的输尿管下段结石患者；尽管坦索罗辛是目前研究最为广泛的α受体阻滞剂，但本研究的网络Meta分析结果显示，特拉唑嗪与多沙唑嗪可能具有更优的疗效。良好的风险获益比支持α受体阻滞剂在经合理筛选的输尿管结石患者中常规应用。