Herbal extract improves ureteral stone passage in phase 3 trial

Clinical takeaway: A 28-day course of Desmodium styracifolium total flavone capsules modestly increased spontaneous passage of 5-10 mm ureteral stones and may offer an additional medical expulsive therapy option for selected patients.

No oral drug is currently approved specifically for urolithiasis, and the effectiveness of existing medical expulsive therapies remains debated. New options that can help patients avoid procedural intervention are needed, particularly for larger ureteral stones.

In this phase 3, double-blind trial, 606 adults with newly diagnosed ureteral stones at 34 centers in China were randomized to receive Desmodium styracifolium total flavone capsules (Guang Jing) or placebo for 28 days, alongside standard background care. Participants had stones measuring 5-10 mm, with an average stone size of about 6 mm.

By day 28, 45% of patients receiving the herbal extract had confirmed stone passage versus 34% of those receiving placebo, representing a 32% relative increase and an absolute improvement of nearly 11 percentage points. Differences were not significant at day 14, suggesting that a full 4-week treatment course may be needed to realize benefit. The treatment did not significantly improve stone migration distance.

Subgroup analyses suggested greater benefit in patients with larger stones (6-10 mm) and those with single stones. Among patients with distal ureteral stones, nearly two-thirds of those treated with Guang Jing passed their stones by day 28. Adverse events occurred in about 19% of patients in both groups, and serious adverse events were rare and considered unrelated to treatment.

“These findings suggest that Guang Jing may be an additional medical expulsive therapy option for appropriately selected patients,” the investigators concluded.

Source: Wang D, et al. (2026 Sep 10) JAMA Netw Open. Desmodium styracifolium Total Flavone Capsules for Urolithiasis: A Phase 3 Randomized Clinical Trial