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Medical Expulsive Therapy: Worthwhile or Wishful Thinking

  • Endourology (P Mucksavage, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

We set out to provide an overview of the most recent evidence for medical expulsive therapy (MET). Conflicting level 1 evidence for and against the use of MET has been published.

Recent Findings

The largest double-blind randomized control trial (1110 patients) comparing placebo, tamsulosin, and nifedipine found no benefit for MET in preventing the need for secondary intervention. A recent meta-analysis of 55 randomized trials using alpha-blockers suggests that no benefit is seen with smaller ureteric calculi, but patients with larger ureteric calculi experience shorter times to stone passage, fewer episodes of pain, require less surgical intervention, and fewer hospital admissions. All the major urological organizations (American Urological Association, European Association of Urology, Canadian Urological Association) suggest offering MET as part of conservative management for appropriate patients with ureteric calculi.

Summary

MET is a reasonable option for conservative management of ureteric calculi that may avoid the need for surgical intervention. The greatest benefit is likely seen with alpha-blockers and calculi ≥5 mm in the distal ureter. Expanding indications for the use of MET include facilitating stone fragment clearance after SWL. MET appears to be safe for use in pregnant and pediatric patients.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. St Michael’s Hospital, University of Toronto, 61 Queen St E – suite 2-012, Toronto, Ontario, M5C 2T2, Canada

    Tad Kroczak, Kenneth T. Pace & Jason Y. Lee

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  1. Tad Kroczak
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  2. Kenneth T. Pace
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Correspondence to Jason Y. Lee.

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Conflict of Interest

Tad Kroczak and Jason Y. Lee each declare no potential conflicts of interest.

Kenneth T. Pace reports grant support from Cook Urological and personal fees from Amgen and Astellas.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Endourology

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Kroczak, T., Pace, K.T. & Lee, J.Y. Medical Expulsive Therapy: Worthwhile or Wishful Thinking. Curr Urol Rep 18, 29 (2017). https://doi.org/10.1007/s11934-017-0673-z

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