Mirabegron for medical expulsive therapy of ureteral stones: a systematic review and meta-analysis
Related Experiment Video
Updated: Jul 5, 2025
Breathing-controlled Electrical Stimulation BreEStim for Management of Neuropathic Pain and Spasticity
Published on: January 10, 2013
Haifeng Song1, Lei Liang1, Hui Liu1
1Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Objective:
To systematically review and quantitively evaluate the efficacy and safety of mirabegron as a medical expulsive therapy for ureteral stones.
Methods:
We performed an extensive search of the EMBASE and PubMed databases for studies examining the use of mirabegron as a medical expulsive therapy for ureteral stones. The primary outcome measure assessed was the stone expulsion rate (SER), while the secondary outcomes evaluated were the stone expulsion interval (SEI) and the occurrence of pain episodes during follow-up. Risk ratios (RRs) and mean differences (MDs) with their respective 95% CIs were calculated.
Results:
We included a total of seven studies involving 728 participants. Our analysis revealed a significant increase in the stone expulsion rate (SER) with mirabegron (RR = 1.40; 95% CI = 1.17-1.67; p < 0.001) and a reduction in the frequency of pain episodes (MD = -0.80; 95% CI = -0.39 to -0.21; p = 0.008) compared to the control group. No significant difference was found in SEI between the two groups (MD = -3.04; 95% CI = -6.33 to 0.25; p = 0.07). Subgroup analysis revealed that the increased SER was significant for distal ureteral stones, but not for proximal and middle ureter stones. Compared to tamsulosin or silodosin, mirabegron showed no significant difference in SER, SEI, or pain episode frequency. The adverse effects of mirabegron were relatively rare and mild.
Conclusion:
Mirabegron appears to be a promising candidate for the MET of distal ureteral stones rather than proximal and middle ureteral stones, as it significantly increases SER and reduces pain episode frequency. Further well-designed randomised controlled trials are needed to validate and affirm these findings.
Systematic Review Registration:
PROSPERO (CRD42022341603).
Insights
Mirabegron effectively increases the stone expulsion rate for distal ureteral stones and reduces pain episodes. This study suggests mirabegron as a potential medical expulsive therapy for ureteral stones, particularly in the distal ureter.
Area of Science:
- Urology
- Pharmacology
- Medical Expulsive Therapy
Background:
- Ureteral stones pose a significant clinical challenge, necessitating effective medical expulsive therapy (MET).
- Mirabegron, a beta-3 adrenergic agonist, has emerged as a potential agent for MET, but its efficacy requires systematic evaluation.
- Current evidence on mirabegron's role in ureteral stone management is fragmented, necessitating a quantitative synthesis.
Approach:
- A systematic review and meta-analysis were conducted using EMBASE and PubMed databases.
- Seven studies involving 728 participants were analyzed to assess mirabegron's efficacy and safety for ureteral stones.
- Primary outcome was stone expulsion rate (SER); secondary outcomes included stone expulsion interval (SEI) and pain episodes. Risk ratios and mean differences were calculated.
Key Points:
- Mirabegron significantly increased the stone expulsion rate (SER) (RR = 1.40; 95% CI = 1.17-1.67) and reduced pain episodes (MD = -0.80; 95% CI = -0.39 to -0.21).
- The positive effect on SER was significant for distal ureteral stones but not for proximal or middle ureter stones.
- Mirabegron demonstrated a comparable efficacy to tamsulosin or silodosin with rare and mild adverse effects.
Conclusions:
- Mirabegron is a promising MET for distal ureteral stones, enhancing stone expulsion and alleviating pain.
- Its efficacy for proximal and middle ureteral stones requires further investigation.
- Additional high-quality randomized controlled trials are recommended to confirm these findings and establish mirabegron's role in ureteral stone management.
Related Concept Videos
01:17Drugs for Treatment of Diarrhea-Predominant IBS
Two specific drugs used in the treatment are alosetron (Lotronex) and eluxadoline (Viberzi). Alosetron, a 5-HT3 antagonist, works by slowing the movement of stools in the gut, reducing bowel...
01:21Drugs for Treatment of Constipation-Predominant IBS
01:20Antiepileptic Drugs: Potassium Channel Activators
Ezogabine has gained approval as an adjunctive treatment...
01:23Upper Respiratory Drugs: Antitussives, Expectorants, and Mucolytics
Antitussives include codeine, dextromethorphan (Robitussin), and benzonatate (Tessalon). Codeine and dextromethorphan exert their effects centrally by suppressing the cough reflex center in the medulla. Benzonatate operates peripherally within the respiratory tract by...
01:28Renal Drug Excretion: Tubular Secretion