Medical Expulsive Therapy after Extracorporeal Shock Wave Lithotripsy: A Systematic Review and Network Meta-Analysis

Medical expulsive therapy (MET) after extracorporeal shock wave lithotripsy (ESWL) remains a subject of debate. We aimed to evaluate the comparative efficacy and safety of various pharmacological interventions using a network meta-analysis (NMA) of 21 randomized controlled trials (RCTs).

A systematic search of PubMed, EMBASE, and the Cochrane Library was conducted through 2024 (Open Science Framework registered). We included only purely pharmacological RCTs, strictly excluding non-randomized studies and device-assisted trials. A Bayesian NMA was performed to estimate odds ratios and the surface under the cumulative ranking curve (SUCRA) for stone-free rates and complications.