Medical Expulsive Therapy for Ureteral Stones: No Better Than Placebo

Summary and Comment |
May 28, 2015

Medical Expulsive Therapy for Ureteral Stones: No Better Than Placebo

  1. Bruce Soloway, MD

In a randomized trial, relaxant medications were not effective.

  1. Bruce Soloway, MD

Guidelines for managing stone-related ureteral colic suggest using “medical expulsive therapy” with smooth muscle relaxants such as tamsulosin or nifedipine (e.g., European Association of Urology Urolithiasis Guideline 2015); however, the two meta-analyses supporting these recommendations include primarily small, single-center trials of low-to-moderate quality.

To evaluate the effectiveness of medical expulsive therapy more rigorously, researchers in the U.K. enrolled 1136 symptomatic adults, each with a single ureteral stone <10 mm in diameter identified by computed tomography and without sepsis or an indication for immediate intervention. Participants were randomized to receive once-daily tamsulosin (0.4 mg), nifedipine (30 mg), or placebo for 4 weeks.

During treatment, about 20% of patients in each group required additional interventions to assist with stone passage. In the 8 weeks after treatment, about 7% of patients in each group required interventions. Patients' sex, stone size, and stone location did not affect outcomes. Analgesic use, time to stone passage, and overall health status were similar in all three groups.

Comment

This trial, designed to reflect current recommendations and clinical practice, not only definitively demonstrates the ineffectiveness of medical expulsive therapy for ureteral stones but also reaffirms the essential importance of large, well-designed, randomized trials for assessing clinical interventions and formulating treatment guidelines.

Editor Disclosures at Time of Publication

  • Disclosures for Bruce Soloway, MD at time of publication Nothing to disclose

Citation(s):

Reader Comments (1)

Alexander Tan, Jr., MD, FACP Physician, Nephrology, Chairman Dept of Medicine, Cebu Doctors' university college of medicine

Agree that more RCTs should be done. I have some success with medical expulsive treatment but I do not limit myself to tamsulosin alone, I added pinene oil (rowatinex), potassium citrate, and a processed herbal remedy which acts like a diuretic. Thanks

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