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  • Review Article
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Medical expulsive therapy for ureteral stones: where do we go from here?

Nature Reviews Urology volume 13, pages 608–612 (2016)Cite this article

Subjects

Key Points

  • Historically, conclusions of several systematic reviews and meta-analysis, based largely on low-quality evidence, suggest that medical expulsive therapy (MET) is effective in patients with ureteral stones

  • Data from two randomized controlled trials published in 2015 have challenged the previously well-accepted role of MET

  • Uncertainty currently exists on the exact role of MET in the management of patients with ureteral stones

  • MET might be beneficial for patients with distal ureteral stones >5 mm, although further research is required to confirm this suggestion

Abstract

Despite two decades of clinical use, the effectiveness of medical expulsive therapy (MET) for the noninvasive management of patients with ureteral stones has, in the past year, been called into in question. The primary aim of MET is to expedite stone passage, although it has also shown effectiveness in reducing time to stone passage, thus reducing the incidence of colic episodes, improving stone clearance and improving patients' quality of life. At least 11 systematic reviews and meta-analyses have been published showing clinical benefits of MET; however, the results of these analyses have been challenged by data from two randomized controlled, multicentre trials with large patient cohorts, thus providing higher quality evidence that MET is ineffective in patients with ureteral stones. Results of the various systematic reviews and meta-analyses have suggested that MET is effective, however, such analyses incorporate the biases and limitations of smaller cohort studies, resulting in their conclusions being based upon lower-quality evidence. Evidence for the use of MET for small (<5 mm) distal ureteral stones has weakened based on clinical trial data published in 2015. However, MET might remain effective in the management of larger ureteral stones (>5 mm).

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Author information

Authors and Affiliations

  1. Department of Urology, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK

    Bhaskar K. Somani

  2. Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK

    Omar Aboumarzouk

  3. Tenon University Hospital, Pierre and Marie Curie, University, 4 rue de la Chine, Paris, 75020, France

    Olivier Traxer

  4. Department of Urology, AMC University Hospital, Meibergdreef 9, Amsterdam, 1105AZ, Netherlands

    Joyce Baard, Guido Kamphuis & Jean de la Rosette

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  1. Bhaskar K. Somani
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Contributions

B.K.S. and O.A. researched data for this article, all authors made a substantial contribution to discussions of content, B.K.S. and O.A. wrote the manuscript, and all authors edited and/or reviewed the manuscript prior to submission.

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Correspondence to Jean de la Rosette.

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The authors declare no competing financial interests.

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Somani, B., Aboumarzouk, O., Traxer, O. et al. Medical expulsive therapy for ureteral stones: where do we go from here?. Nat Rev Urol 13, 608–612 (2016). https://doi.org/10.1038/nrurol.2016.146

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