{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T04:09:59Z","timestamp":1775707799316,"version":"3.50.1"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2024,12,27]],"date-time":"2024-12-27T00:00:00Z","timestamp":1735257600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction and aim<\/jats:title>\n<jats:p>The main categories of drugs employed for medical expulsive therapy in patients with ureteral calculi (UC) are alpha-blockers (\u03b1-B) and beta-adrenoceptor agonists. This meta-analysis evaluated the safety and effectiveness of \u03b1-B versus mirabegron (MIR) in treating UC.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>From January 1980 to October 2024, we extensively searched the Pubmed, Web of science, Cochrane and EMBASE databases to identify randomized controlled trials (RCTs) that compared the effectiveness of \u03b1-B and MIR in managing UC. Furthermore, a systematic review and meta-analysis were carried out.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The meta-analysis included six publications with 592 patients, comparing \u03b1-B with MIR. The stone expulsion rate (SER) was found to be significantly greater in the \u03b1-B group than in the MIR group, as indicated by an odds ratio (OR) of 1.51 (95% confidence interval [CI]: 1.05 to 2.16, P = 0.03) in the meta-analysis. However, no significant differences were found between the \u03b1-B group and the MIR group for stone expulsion time (SET) (mean difference [MD]: 1.20; 95% CI, -2.71 to 5.10; P = 0.55), pain episodes (PE) (MD: 0.36; 95% CI, -0.04 to 0.76; P = 0.07), or analgesic requirements (MD: 0.79; 95% CI, -0.37 to 1.94; P = 0.18). The \u03b1-B group exhibited a significantly higher incidence of adverse events compared to the MIR group for orthostatic hypotension (OR 12.16, 95% CI 3.36 to 43.95, P = 0.0001), headache (OR 3.46, 95% CI 1.41 to 8.49, P = 0.007), and retrograde ejaculation (OR 16.30, 95% CI 5.87 to 45.31, P &lt; 0.00001). While in the dizziness (OR 1.65, 95% CI 0.67 to 4.09, p = 0.28), it made no difference.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Our meta-analysis identified a substantial enhancement in the SER among patients with UC who received \u03b1-B therapy instead of those who were administered MIR therapy. Nonetheless, \u03b1-B therapy was connected to an increased risk of adverse events.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Systematic review registration<\/jats:title>\n<jats:p>PROSPERO, ID <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD42024595934\" xlink:type=\"simple\">CRD42024595934<\/jats:ext-link>.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0315328","type":"journal-article","created":{"date-parts":[[2024,12,27]],"date-time":"2024-12-27T18:24:29Z","timestamp":1735323869000},"page":"e0315328","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Evaluating the safety and effectiveness of \u03b1-blockers versus mirabegron for medical expulsive therapy in ureteral calculi: A Systematic review and meta-analysis"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8418-5134","authenticated-orcid":true,"given":"Huilei","family":"Yan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoni","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaobo","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuanshan","family":"Cui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,12,27]]},"reference":[{"key":"pone.0315328.ref001","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1159\/000020094","article-title":"Increase in the prevalence of symptomatic upper urinary tract stones during the last ten years","volume":"37","author":"A Trinchieri","year":"2000","journal-title":"Eur Urol"},{"key":"pone.0315328.ref002","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.eururo.2012.03.052","article-title":"Prevalence of kidney stones in the United States","volume":"62","author":"Urologic Diseases in America Project","year":"2012","journal-title":"Eur Urol"},{"key":"pone.0315328.ref003","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1053\/j.ajkd.2011.03.021","article-title":"Association between metabolic syndrome and the presence of kidney stones in a screened population","volume":"58","author":"IG Jeong","year":"2011","journal-title":"Am J Kidney Dis"},{"key":"pone.0315328.ref004","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/j.eururo.2015.07.041","article-title":"EAU Guidelines on Interventional Treatment for Urolithiasis","volume":"69","author":"C T\u00fcrk","year":"2016","journal-title":"Eur Urol"},{"issue":"Suppl 1","key":"pone.0315328.ref005","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1111\/bcpt.13613","article-title":"Current and emerging pharmacological targets for medical expulsive therapy","volume":"130","author":"I Lim","year":"2022","journal-title":"Basic Clin Pharmacol Toxicol"},{"key":"pone.0315328.ref006","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1016\/j.eururo.2019.07.053","article-title":"Medical Expulsive Therapy for Urinary Stones: Future Trends and Knowledge Gaps","volume":"76","author":"V De Coninck","year":"2019","journal-title":"Eur Urol"},{"key":"pone.0315328.ref007","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1055\/a-0770-2627","article-title":"Is Medical Therapy for Distal Ureteral Stones Efficient? Tamsulosin versus Deflazacort: A Prospective Randomised Trial","volume":"53","author":"S Kucukpolat","year":"2022","journal-title":"Aktuelle Urol"},{"key":"pone.0315328.ref008","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/j.eururo.2009.03.076","article-title":"Is there a role for tamsulosin in the treatment of distal ureteral stones of 7 mm or less? Results of a randomised, double-blind, placebo-controlled trial","volume":"56","author":"T Hermanns","year":"2009","journal-title":"Eur Urol"},{"key":"pone.0315328.ref009","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1111\/bju.14454","article-title":"\u03b1-blockers as medical expulsive therapy for ureteric stones: a Cochrane systematic review","volume":"122","author":"T Campschroer","year":"2018","journal-title":"BJU Int"},{"key":"pone.0315328.ref010","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1111\/bcp.12737","article-title":"Efficacy and safety of silodosin in the medical expulsion therapy for distal ureteral calculi: a systematic review and meta-analysis","volume":"81","author":"W Huang","year":"2016","journal-title":"Br J Clin Pharmacol"},{"key":"pone.0315328.ref011","doi-asserted-by":"crossref","first-page":"e27272","DOI":"10.1097\/MD.0000000000027272","article-title":"The efficacy and safety of alpha-adrenergic blockers for medical expulsion therapy in 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Tang","year":"2021","journal-title":"World J Urol"},{"key":"pone.0315328.ref018","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1007\/s00240-018-1075-5","article-title":"Efficacy of mirabegron in medical expulsive therapy","volume":"47","author":"M Solakhan","year":"2019","journal-title":"Urolithiasis"},{"key":"pone.0315328.ref019","first-page":"2293182","article-title":"The Efficacy of Mirabegron in Medical Expulsive Therapy for Ureteral Stones: A Systematic Review and Meta-Analysis","volume":"2022","author":"D Cai","year":"2022","journal-title":"Int J Clin Pract"},{"key":"pone.0315328.ref020","doi-asserted-by":"crossref","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"JPT 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