Distal ureteral stones are a common urologic issue, and medical expulsive therapy (MET) is widely used as a non-invasive treatment. Tamsulosin, Silodosin, and Tadalafil are frequently prescribed to promote stone passage. This meta-analysis compares the efficacy of these agents in aiding stone expulsion.

A systematic search of PubMed, Cochrane Library, and Airiti Library was conducted for studies published up to April 2025. Included studies assessed Tamsulosin, Silodosin, or Tadalafil in patients with distal ureteral stones. Studies lacking relevant MET data were excluded. The primary outcome was the stone-free rate. Meta-analysis was performed using Review Manager 5.4 to calculate pooled relative risks (RR) and 95% confidence intervals (CI).

Three randomized controlled trials involving 563 patients were included. Tamsulosin vs. Silodosin: Tamsulosin showed a slightly higher stone-free rate (RR = 0.94; 95% CI: 0.84–1.04; p = 0.23; I² = 79%). Tamsulosin vs. Tadalafil: Tamsulosin again showed a higher rate (RR = 0.92; 95% CI: 0.81–1.04; p = 0.18; I² = 44%). Tadalafil vs. Silodosin: Tadalafil had a slightly better outcome (RR = 0.94; 95% CI: 0.84–1.04; p = 0.23; I² = 79%). None of the comparisons were statistically significant.

Tamsulosin and Tadalafil showed a trend toward better outcomes than Silodosin, with Tamsulosin slightly outperforming Tadalafil. However, the differences were not statistically significant. Further large-scale trials are needed to confirm these results.