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LETTER TO EDITOR
Year : 2023  |  Volume : 39  |  Issue : 2  |  Page : 177-178
 

Re: Ramadhani MZ, Kloping YP, Rahman IA, Yogiswara N, Soebadi MA, Renaldo J. Silodosin as a medical expulsive therapy for distal ureteral stones: A systematic review and meta-analysis. Indian J Urol 2023;39:21-6


Department of Urologic Oncology, Max Institute of Cancer Care, Saket, New Delhi, India

Date of Submission30-Dec-2022
Date of Acceptance20-Mar-2023
Date of Web Publication31-Mar-2023

Correspondence Address:
Gopal Sharma
Department of Urologic Oncology, Max Institute of Cancer Care, Saket, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iju.iju_439_22

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How to cite this article:
Sharma G. Re: Ramadhani MZ, Kloping YP, Rahman IA, Yogiswara N, Soebadi MA, Renaldo J. Silodosin as a medical expulsive therapy for distal ureteral stones: A systematic review and meta-analysis. Indian J Urol 2023;39:21-6. Indian J Urol 2023;39:177-8

How to cite this URL:
Sharma G. Re: Ramadhani MZ, Kloping YP, Rahman IA, Yogiswara N, Soebadi MA, Renaldo J. Silodosin as a medical expulsive therapy for distal ureteral stones: A systematic review and meta-analysis. Indian J Urol 2023;39:21-6. Indian J Urol [serial online] 2023 [cited 2023 May 30];39:177-8. Available from: https://www.indianjurol.com/text.asp?2023/39/2/177/373135


I read with great interest an article published by Ramadhani et al.[1] in the latest edition of the Journal. In this study, the authors have performed a systematic review and meta-analysis of the studies examining the role of silodosin as a medical expulsive therapy for distal ureteric stones. I would like to congratulate the authors on their publication. Multiple randomized control trials have established the efficacy of alpha-blockers as a part of medical expulsive therapy for distal ureteric stones. Most of the studies conducted in this field have been small, single-center, poor-quality randomized studies. Therefore, there is still a scope for a well-conducted multicentric randomized control trial to close this debate. This is where systematic reviews and meta-analyses have proved handy by performing a pooled analysis of these small randomized studies. However, this pooling of data may not be without limitations as there would be heterogeneity in the patient population and outcomes studied. In the present meta-analysis, the authors have tried to handle this delicate issue; however, there are still limitations that need to be addressed.

One important limitation of this study that needs to be highlighted is the fact that the placebo or control group was different in the included studies. Most of the included studies did not include a classical “placebo” group but instead had a no-treatment group with hydration with or without anti-inflammatory drugs as control. Second, the authors have included a study by Rathi et al.,[2] which was actually a conference abstract. In the methods' section, the authors have not adequately highlighted how they handled conference abstracts. Were the data readily available from the study by Rathi et al. to perform pooled and risk-of-bias analysis or did the authors have to contact the original study author for full-text? In any situation, it is generally recommended that conference abstracts should not be included in the systematic reviews as they do not undergo a stringent peer-review process. Furthermore, I have reservations over the inclusion of a study by Cholaraju et al.[3] in the present review. This study did not clearly define the randomization technique and outcome parameters. None of the previous reviews have included this study and we also excluded this study from our two published reviews on the topic due to the reasons mentioned above.[4],[5],[6] Heterogeneity due to imaging modality and duration for determining stone-free rate is also an important factor to consider and should have been highlighted in the limitations section. Finally, the authors have not clarified in the introduction section regarding the need for this study. What was the knowledge gap in the literature for which they developed the research question for this study? In my opinion, the study question has been a part of multiple reviews with similar findings published in the past, thereby suggesting redundancy of the current review.[5],[6],[7],[8],[9],[10] Furthermore, the authors have not compared their results with the results of previous studies in the discussion section, which in my opinion are not much different from that of the present study. For instance, in a previous network meta-analysis by Sharma et al., comparing three commonly used alpha-blockers for distal ureteric stones, silodosin was noted to be the most efficacious drug.[6]

Further minor issues that need rectification/clarification include:

  • References to the included studies cited in Table 1 seem to be incorrect
  • The authors have been quite generous in the risk of bias analysis as most of the included studies were of low quality
  • In Figure 3, instead of fixed-effect analysis, the random-effect analysis should have been used as there was a significant statistical heterogeneity.
  • The authors should also include publication bias either by Funnel plot or by Egger's method.


Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.

 
   References Top

1.
Ramadhani MZ, Kloping YP, Rahman IA, Yogiswara N, Soebadi MA, Renaldo J. Silodosin as a medical expulsive therapy for distal ureteral stones: A systematic review and meta-analysis. Indian J Urol 2023;39:21-6.  Back to cited text no. 1
  [Full text]  
2.
Rathi S, Agarwal A, Patnaik P, Shaw D, Trivedi S, Dwivedi US. Evaluation of medical expulsive therapy for distal ureteral stone: A prospective randomized controlled study to compare silodosin versus tamsulosin. Indian J Urol 2014;30 Suppl 1:S83.  Back to cited text no. 2
    
3.
Cholaraju RS, Aithal K, Ali PA, Khan A. Effect of α-adrenergic blockers silodosin in the management of distal ureteric calculus. Int Surg J 2020;7:689-92.  Back to cited text no. 3
    
4.
Huang W, Xue P, Zong H, Zhang Y. Efficacy and safety of silodosin in the medical expulsion therapy for distal ureteral calculi: A systematic review and meta-analysis. Br J Clin Pharmacol 2016;81:13-22.  Back to cited text no. 4
    
5.
Sharma G, Kaundal P, Pareek T, Tyagi S, Sharma AP, Devana SK, et al. Comparison of efficacy of various drugs used for medical expulsive therapy for distal ureter stones: A systematic review and network meta-analysis. Int J Clin Pract 2021;75:e14214.  Back to cited text no. 5
    
6.
Sharma G, Pareek T, Kaundal P, Tyagi S, Singh S, Yashaswi T, et al. Comparison of efficacy of three commonly used alpha-blockers as medical expulsive therapy for distal ureter stones: A systematic review and network meta-analysis. Int Braz J Urol 2022;48:742-59.  Back to cited text no. 6
    
7.
Ding H, Ning Z, Dai Y, Shang P, Yang L. The role of Silodosin as a new medical expulsive therapy for ureteral stones: A meta-analysis. Ren Fail 2016;38:1311-9.  Back to cited text no. 7
    
8.
Liu H, Wang S, Zhu W, Lu J, Wang X, Yang W. Comparative efficacy of 22 drug interventions as medical expulsive therapy for ureteral stones: A systematic review and network meta-analysis. Urolithiasis 2020;48:447-57.  Back to cited text no. 8
    
9.
Liu XJ, Wen JG, Wan YD, Hu BW, Wang QW, Wang Y. Role of silodosin as medical expulsive therapy in ureteral calculi: A meta-analysis of randomized controlled trials. Urolithiasis 2018;46:211-8.  Back to cited text no. 9
    
10.
Yang D, Wu J, Yuan H, Cui Y. The efficacy and safety of silodosin for the treatment of ureteral stones: A systematic review and meta-analysis. BMC Urol 2016;16:23.  Back to cited text no. 10
    




 

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