TITLE:
Managing Ureteral Stent-Related Symptoms: A Meta-Analysis Comparing Tadalafil with Tamsulosin
AUTHORS:
Abdullah Elrashidy, Alaa Mousa, Gaber M. Elsafy, Mahmoud Shaaban
KEYWORDS:
Ureteral Stent, Double-J Stent, Stent-Related Symptoms, Tadalafil, Tamsulosin, Phosphodiesterase Type 5 Inhibitor, Alpha-Blocker, Ureteral Stent Symptom Questionnaire
JOURNAL NAME:
Open Journal of Urology,
Vol.16 No.10,
October
23,
2026
ABSTRACT: Introduction: Ureteral stent-related symptoms (SRSs), colloquially termed “stent syndrome”, represent a post-operative morbidity impacting up to 80% of patients following endourological procedures. Although alpha1-blockers are the traditional standard of care, their efficacy in controlling stent-induced body pain and associated sexual dysfunction is often limited. This systematic review and meta-analysis evaluates the comparative therapeutic efficacy and safety profile of tadalafil versus tamsulosin across isolated monotherapy and combination therapy regimens. Methods: PubMed/MEDLINE, Embase, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception through May 15, 2026 for randomized controlled trials in adults with indwelling ureteral stents. Eligible trials directly compared tadalafil monotherapy with tamsulosin monotherapy, or tadalafil plus tamsulosin with tamsulosin alone. Outcomes of interest were Ureteral Stent Symptom Questionnaire (USSQ) domains and adverse events. Higher USSQ symptom-domain scores indicate greater symptom burden. Trial identity, arm-level denominators, drug doses, assessment timing, and bibliographic attribution were rechecked against the primary reports. Quantitative pooling was undertaken only when trial-level means, dispersion measures, and analyzable denominators were sufficiently and comparably reported; otherwise, findings were synthesized narratively to avoid unverifiable imputation. Results: Five verifiable randomized studies directly compared tadalafil and tamsulosin monotherapies: Aggarwal et al. (2015), Chauhan et al. (2019), Balaji et al. (2020), Ilyas et al. (2021), and Komisarenko et al. (2024). Across these trials, tadalafil generally produced greater improvement in pain-related and sexual-matters outcomes, whereas urinary-symptom results were broadly similar or favored tamsulosin in some assessments. Komisarenko et al. additionally randomized patients to tadalafil 5 mg plus tamsulosin 0.4 mg and reported lower urinary-symptom and body-pain burden with combination therapy than with either monotherapy. A previously cited second combination trial could not support the original two-study pooled estimate under the prespecified 0.4-mg tamsulosin comparator criterion. The primary reports were heterogeneous in endpoint timing and statistical reporting, and several did not provide the domain-specific standard deviations and analyzable sexual-domain denominators required for a defensible pooled mean difference. Accordingly, unsupported pooled effect estimates and adverse-event risk ratios from the earlier manuscript were not retained. Conclusion: Randomized evidence supports tadalafil as a reasonable alternative to tamsulosin for selected patients with ureteral stent-related symptoms, with the most consistent signal favoring tadalafil for pain-related and sexual-domain outcomes. Urinary-symptom control is not consistently superior with tadalafil. Combination tadalafil plus tamsulosin is promising, but the evidence meeting the prespecified comparator definition is currently insufficient for a robust pooled estimate. The certainty of the evidence is limited by small trials, heterogeneous assessment schedules, incomplete domain-specific reporting, and potential bias in patient-reported outcomes.