The possibility of using mirabegron as a new medical expulsive therapy agent for ureteral stones has been studied owing to its relaxant effects on the ureteral smooth muscle. The objective of this study was to update the evidence regarding the efficacy of mirabegron in medical expulsive therapy for the management of ureteral calculi. We systematically searched PubMed, Cochrane library and Embase to collect the clinical trials from inception dates to August 2022. Meta-analysis and forest-plot figures were calculated with the software review manager v5.0. Six studies with 462 patients were eligible for inclusion. Mirabegron achieved significantly higher expulsion rate than control (pooled RR: 1.44, 95% CI: 1.12, 1.86; P = 0.004). A subgroup analyses showed that mirabegron has a significantly higher expulsion rate on stone sizes smaller than 5/6 mm (RR 1.4; 95% CI: 1.11–1.77; P = 0.005). The superior effect was not observed on stone sizes > 5/6 mm (RR 1.04; 95% CI: 0.80–1.35; P = 0.77). The pooled data showed no significant difference in the expulsion time between mirabegron and control group (MD: -0.53, 95% CI -5.77–4.71; P = 0.84). There was no significant difference between the mirabegron group and the control group in the episodes of renal colic (MD -0.18; 95% CI -0.39–0.02; P = 0.08). But patients receiving mirabegron had less analgesic consumption. No serious adverse events were reported with mirabegron treatment. This systematic review shows that mirabegron is an effective and safe medical expulsive therapy agent in patients with ureteral stones.