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

ContextMedical 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.ObjectiveOur aim was to summarize the literature on MET in the treatment of urolithiasis.Evidence acquisitionThis paper is based on a presentation given at the symposium “Terpenes in Urolithiasis” that was held in Düsseldorf, Germany, in 2010.Evidence synthesisMET with α-blockade and calcium channel blockade resulted in accelerated and higher expulsion rates compared with a control group. Higher expulsion rates were demonstrated for the entire ureter, although the vast majority 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.ConclusionsMET 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.