What question did this study set out to answer?

This investigation aims to compare the efficacy of silodosin and tadalafil as medical expulsive therapies for patients with lower ureteric calculi.

May 10, 2026Open Access

Effectiveness of Silodosin versus Tadalafil as Medical Expulsive Therapy for Lower Ureteric Calculi: A Randomized Controlled Trial

Key Points

This investigation aims to compare the efficacy of silodosin and tadalafil as medical expulsive therapies for patients with lower ureteric calculi.
Randomized controlled trial with 90 patients split into two groups: silodosin (Group A) and tadalafil (Group B).
Evaluation of patient demographics, stone characteristics, ejection rates, and pain episodes.
Analysis of analgesic use and expulsion duration.
Silodosin reduced analgesic use (198.8 mg vs. 247.8 mg, p < 0.001).
Silodosin led to fewer pain episodes (1.1 vs. 2.5, p < 0.001) and higher expulsion rates (80.0% vs. 60.0%, p < 0.001).
Silodosin had a longer expulsion duration (14.4 vs. 17.7 days, p < 0.001) but was associated with more irregular ejaculation (17.8% vs. 4.4%).

Abstract

Background: Medical expulsive therapy (MET) helps patients with lower ureteric calculi (LUC) pass their stones more easily. Although tadalafil and silodosin are promising MET agents, it is yet unknown how effective they are in comparison. The treatment efficacy of these medicines in LUC patients was compared in the current investigation. Methods: 90 patients were divided into two groups at random and given tadalafil (Group B) and silodosin (Group A) as prospective treatments. Every patient's age, sex, stone type, size, ejection rate, and pain episodes were noted and examined. Results: Groups A and B had mean ages of 39.1 (± 8.0) and 37.4 (± 8.2) years, respectively. With mean BMI values (kg/m2) of 27.1 (± 1.7) and 27.5 (± 1.6) for Groups A and B, respectively, the groups' sex distribution and comorbidities were comparable. Additionally, the mean stone type (radiopaque: 75.6% vs. 80.0%) and size (7.6 mm vs. 7.8 mm) were comparable. Silodosin treatment, however, resulted in a lower use of analgesics (198.8 mg vs. 247.8 mg, p < 0.001), fewer pain episodes (1.1 vs. 2.5, p < 0.001), and a greater expulsion rate (80.0% vs. 60.0%) and shorter expulsion duration (14.4 vs. 17.7 days, p < 0.001). With the exception of frequent irregular ejaculation with silodosin (17.8% vs. 4.4%), the side effects were comparable. Conclusion: In conclusion, even though silodosin is linked to an increased risk of irregular ejaculation, it is superior to tadalafil in encouraging stone removal while lowering pain episodes. Clinical Trial Registration: CTRI/2025/03/082491

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