Medical expulsive therapies for ureteric stones: an umbrella review of network meta-analyses with novel evidence grading.
Umm E Salma Shabbar Banatwala, Areesha Mansoor, Mohamed Fawzy et al.
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In 30 seconds
This umbrella review compared medical expulsive therapies (METs) for ureteric stone expulsion by synthesising published network meta-analyses of randomised controlled trials. Eight network meta-analyses covering 147 trials were included, with 24.5% overall overlap between their studies. Using a modified GRADE approach incorporating AMSTAR-2, the authors judged certainty high to moderate in five analyses and low in three. Naftopidil plus corticosteroids ranked highest in analyses of high and moderate certainty (SUCRA 91.8% and 90.6%); silodosin also ranked highly, though in moderate- and low-certainty analyses.
Key findings
- Eight network meta-analyses included 147 randomised controlled trials; overall study overlap was 24.5%.
- Evidence certainty was high to moderate in five network meta-analyses and low in three.
- Naftopidil plus corticosteroids had SUCRA values of 91.8% and 90.6% in one high- and one moderate-certainty analysis.
- Silodosin had SUCRA values of 94.8% and 82.5% in one moderate- and one low-certainty analysis.
Why it matters
The review collates comparative rankings across network meta-analyses, helping clinicians interpret which METs appear most effective for stone expulsion and how much confidence to place in those rankings. The differing certainty levels matter: a high ranking is not equally well supported across therapies, and the findings can also help identify where further comparative research is needed.
What to keep in mind
The review depends on existing network meta-analyses, which had substantial overlap in included studies; certainty was low in three of the eight analyses.