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Background <p>There is uncertainty about the ranking of effectiveness of the available medical expulsive therapies (MET) for ureteric stones, a common and painful urological condition. We comprehensively compared all currently available METs employing a novel evidence grading system to evaluate published network meta-analyses (NMA).</p> Methods <p>Following prospective registration (PROSPERO CRD #42023472770), we conducted an umbrella review incorporating NMAs of randomized controlled trials (RCTs) evaluating various METs. Literature searches were performed in PubMed, Embase, and Google Scholar until January 2026. The primary outcome was the rate of ureteric stone expulsion. Calculated covered area (CCA) estimated the overlap of studies between NMAs. Evidence certainty was assessed using a novel modified GRADE methodology incorporating AMSTAR-2. Surface under the cumulative ranking curve&#xa0;(SUCRA) based on probability of being the best intervention was used for comparing METs.</p> Results <p>Eight NMAs, comprising 147 RCTs were selected. The CCA showed high (24.5%) overall overlap. Evidence certainty was high-moderate in 5 NMAs, and low in 3. The highest-ranked METs were Naftopidil plus corticosteroids (SUCRA 91.8% and 90.6% in 1 high and 1 moderate certainty NMA) and Silodosin (SUCRA 94.8% and 82.5% in 1 moderate and 1 low certainty NMA).</p> Conclusions <p>Naftopidil plus corticosteroids was the most effective MET for stone expulsion based on evidence certainty assessment, followed by Silodosin. Clinical care and future research should take into account the ranking evidence collated in this umbrella review.</p>

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Medical expulsive therapies for ureteric stones: an umbrella review of network meta-analyses with novel evidence grading

  • 期刊论文

  • 发表日期：

    2026年6月29日

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  • Umm E Salma Shabbar Banatwala,
  • Areesha Mansoor,
  • Mohamed Fawzy,
  • Shayan Ali Khan,
  • Nadeem Bin Nusrat,
  • Khalid Saeed Khan

摘要

Background

There is uncertainty about the ranking of effectiveness of the available medical expulsive therapies (MET) for ureteric stones, a common and painful urological condition. We comprehensively compared all currently available METs employing a novel evidence grading system to evaluate published network meta-analyses (NMA).

Methods

Following prospective registration (PROSPERO CRD #42023472770), we conducted an umbrella review incorporating NMAs of randomized controlled trials (RCTs) evaluating various METs. Literature searches were performed in PubMed, Embase, and Google Scholar until January 2026. The primary outcome was the rate of ureteric stone expulsion. Calculated covered area (CCA) estimated the overlap of studies between NMAs. Evidence certainty was assessed using a novel modified GRADE methodology incorporating AMSTAR-2. Surface under the cumulative ranking curve (SUCRA) based on probability of being the best intervention was used for comparing METs.

Results

Eight NMAs, comprising 147 RCTs were selected. The CCA showed high (24.5%) overall overlap. Evidence certainty was high-moderate in 5 NMAs, and low in 3. The highest-ranked METs were Naftopidil plus corticosteroids (SUCRA 91.8% and 90.6% in 1 high and 1 moderate certainty NMA) and Silodosin (SUCRA 94.8% and 82.5% in 1 moderate and 1 low certainty NMA).

Conclusions

Naftopidil plus corticosteroids was the most effective MET for stone expulsion based on evidence certainty assessment, followed by Silodosin. Clinical care and future research should take into account the ranking evidence collated in this umbrella review.