Medical Expulsive Therapy of Ureteral Calculi and Supportive Therapy After Extracorporeal Shock Wave Lithotripsy

Context: Medical expulsive therapy (MET) augments expulsion rates and reduces colic events. Therefore, MET is an appropriate procedure to facilitate stone passage during the observation period in patients who have a newly diagnosed ureteral stone and whose symptoms are controlled. Increasing evidence indicates that supportive therapy following shock wave lithotripsy (SWL) for urolithiasis is also effective. Objective: Our aim was to summarize the literature on MET in the treatment of urolithiasis. Evidence acquisition: This paper is based on a presentation given at the symposium ‘‘Terpenes in Urolithiasis’’ that was held in Düsseldorf, Germany, in 2010. Evidence synthesis: MET with a-blockade and calcium channel blockade resulted in accelerated and higher expulsion rates compared with a control group. Higher expulsion rateswere demonstrated for the entire ureter, although the vastmajority of studies only included distally located stones. MET showed favorable results for renal stones after extracorporeal SWL. The number of necessary analgesic rescue medications, colic episodes, and hospital admissions during treatment periods was reduced. Conclusions: MET facilitates ureteral stone passage during the observation period in patients who have a newly diagnosed ureteral stone <10 mm and whose symptoms are controlled. In patients harboring renal stones undergoing SWL, stone expulsion is augmented as well. Large-scale placebo-controlled randomized trials and the investigation of promising new substances are still needed to better define the future role of MET. # 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.