Medical Expulsive Therapy

• Medical expulsive therapy should only be used in informed patients if

active stone removal is not indicated.
• Treatment should be discontinued if complications develop (infection,
refractory pain, deterioration of renal function)
• Prior to the use of calcium channel blockers and alpha antagonist,
spontaneous passage was aided with increased fluid intake along with
antiemetics and analgesics.
• In current practice, two treatments have been studied in randomized
controlled trials: Nifedipine and alpha antagonists (i.e., tamsulosin,
doxazosin, alfuzosin, or terazosin).
EAU 2019
Wood KD, Gorbachinsky I, Gutierrez J. Medical Expulsive Theraphy. Indian J Urol. 2014; 30(1): 60-64
Guidelines
• AUA guidelines (2016)  recommend Medical Expulsive Therapy
(MET) only for patients with distal ureteral stones ≤10 mm
• European Association of Urology (EAU) guidelines  recommend use
for all ureteral stones.

Fedrigon DC, Jain R, Sivalingam S. Current Use of Medical Expulsive Theraphy Among Endourologist. Can Urol Assoc J. 2018; 12(9):E384-90
Medical Expulsive Therapy

• Patients treated with α-blockers, calcium-channel inhibitors

(nifedipine) and phosphodiesterase type 5 (PDE-5) inhibitors
(tadalafil) are more likely to pass stones with fewer colic episodes
than those not receiving such therapy
• Tamsulosin showed an overall superiority to nifedipine for distal
ureteral calculi
• Offer α-blockers as medical expulsive therapy as one of the treatment
options for (distal) ureteral stones > 5 mm.

EAU 2019