Efficacy and Safety of Naftopidil in the Medical Expulsion Therapy for Distal Ureteral Stone: A Systematic Review and Meta-Analysis.

PURPOSE: The selective α-adrenoceptor blocker is widely used as a cost-effective treatment option for medical expulsive therapy (MET) of ureteral stones. In this review, we aimed to assess the efficacy and safety of naftopidil for MET compared with control or tamsulosin.

METHODS: A systematic literature search was performed in PubMed, Cochrane Library, Embase, and Google Scholar to identify randomized controlled trials that compared naftopidil with either control or tamsulosin for the management of distal ureteral stones.

RESULTS: We included 7 publications with 553 patients. Naftopidil was not only effective for distal ureteral calculi but also was comparable to tamsulosin in efficacy. The expulsion rate (risk ratio [RR] 2.00, 95% confidence interval [CI] 1.41, 2.83; P < 0.0001) and expulsion time (days) of distal ureteral stones (mean difference [MD] -1.72, 95% CI -3.27, -0.18, P = 0.03) indicated that naftopidil was more effective than control. Based on the expulsion rate (RR 1.05, 95% CI 0.74, 1.48; P = 0.80), expulsion time (days) (MD 0.18, 95% CI -0.49, 0.85; P = 0.59), and number of pain episodes (P = 0.87), naftopidil was comparable to tamsulosin. A little lower adverse effect rate was observed with naftopidil compared with tamsulosin (RR 0.47, 95% CI 0.23, 0.94; P = 0.03).

CONCLUSIONS: In terms of efficacy for distal ureteral calculi, naftopidil would be superior to control and comparable to tamsulosin; moreover, the safety profile of naftopidil might be superior to that of tamsulosin. We conclude that naftopidil might be a powerful candidate in MET for distal ureteral stones.