Real-world effectiveness of total flavonoids from Desmodium styracifolium for ureteral stones: a propensity score-matched retrospective cohort study.

BACKGROUND: Ureteral stones frequently lead to urinary tract obstruction, and medical expulsive therapy (MET) continues to serve as a mainstay of non-invasive management. Total flavonoids from Desmodium styracifolium (TFDS), a traditional Chinese herbal extract, have been suggested to promote stone passage, but real-world evidence is limited. METHODS: We performed a retrospective cohort study including 341 outpatients diagnosed with unilateral ureteral stones between January and December 2024. Patients receiving TFDS were classified as the study group (n = 194), while those not receiving TFDS served as controls (n = 147). We used 1:1 propensity score matching to ensure comparable baseline profiles, yielding 142 matched pairs. The primary outcomes were stone expulsion time and expulsion rate within 30 days. Subgroup analyses were performed according to stone size and location. RESULTS: After PSM, all baseline variables were well balanced between the two groups. Patients treated with TFDS experienced a shorter average duration to stone passage than controls (9.06 vs. 12.24 days, p = 0.003). Subgroup analyses showed that TFDS shortened expulsion time in both small (<5 mm) and larger (five to nine mm) stones, as well as across different ureteral locations, with the most marked benefit observed in upper ureteral stones. The overall stone expulsion rate was higher in the TFDS group than in controls (63.4% vs. 47.9%, p = 0.09), with significant improvement in stones 5-9 mm (p = 0.021) and in middle-to-lower ureteral stones (p = 0.011). No adverse drug reactions were reported. CONCLUSION: After adjusting for baseline differences using PSM, TFDS significantly shortened stone expulsion time and improved expulsion rates, particularly for larger and distally located ureteral stones. TFDS appears to be a safe and effective adjunct to MET in the conservative management of ureteral stones.