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Wood KD et al, 2014: Medical expulsive therapy

Wood KD, Gorbachinsky I, Gutierrez J
Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC, USA


Abstract

The objective of this review article is to present the current literature on medical expulsive therapy (MET) and help guide practitioners in the appropriate use of MET for treatment of stone disease. Kidney stones can be treated with multiple modalities including medical therapy, ureteroscopy, shock wave lithotripsy (SWL), percutaneous nephrostolithotomy, open/laparoscopic stone removal, and/or combinations of these modalities. The choice of intervention depends on patient factors, anatomical considerations, surgeon preference, and stone location and characteristics. MET is an excellent treatment modality in the appropriately selected patient. The AUA/EAU guidelines suggest MET as a reasonable treatment choice in select patients. A review of the data suggests the use of alpha antagonist and calcium channel blockers can improve stone expulsion rates. Most data suggests alpha antagonists as superior to calcium channel blockers. There are numerous available alpha antagonists, all of which have supporting data for their use in MET. Evidence suggests that MET can decrease colic events, narcotic use, and hospital visits. MET may also reduce medical costs and prevent unnecessary surgeries and the associated risks. Further, there is a role for alpha antagonists and calcium channel blockers in improving stone passage and decreasing pain in those subjects treated with other modalities (i.e. SWL and ureteroscopy). Despite this evidence, MET remains underutilized as a treatment modality.

Indian J Urol. 2014 Jan;30(1):60-4. doi: 10.4103/0970-1591.124209.
PMID:24497685[PubMed]
PMCID:PMC3897056

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Comments 1

Peter Alken on Tuesday, 25 February 2014 14:13

In this review on the well accepted use of medical expulsive therapy the last reference - even though being also 4 years old - is worth being mentioned separately because it allows a view beyond what is usually published and known:

"Recognizing the underutilization in certain demographic groups and implementing education and changes in the hospital setting will ultimately lead to more appropriate use of MET. Brede et al. performed an educational intervention on ED physicians and analyzed emergency department practices before and after intervention. Following education on the use of MET, the group noticed a fourfold increase in alpha antagonist prescriptions in the emergency room (comparing pre and post intervention) as well as an overall decrease in cost per patient and a decrease in adverse events." (Brede C, Hollingsworth JM, Faerber GJ, Taylor JS, Wolf JS. Medical expulsion therapy for ureteral calculi in the real world: Targeted education increases use and improves patient outcomes. J Urol. 2010;183:585–9)

Peter Alken

In this review on the well accepted use of medical expulsive therapy the last reference - even though being also 4 years old - is worth being mentioned separately because it allows a view beyond what is usually published and known: "Recognizing the underutilization in certain demographic groups and implementing education and changes in the hospital setting will ultimately lead to more appropriate use of MET. Brede et al. performed an educational intervention on ED physicians and analyzed emergency department practices before and after intervention. Following education on the use of MET, the group noticed a fourfold increase in alpha antagonist prescriptions in the emergency room (comparing pre and post intervention) as well as an overall decrease in cost per patient and a decrease in adverse events." (Brede C, Hollingsworth JM, Faerber GJ, Taylor JS, Wolf JS. Medical expulsion therapy for ureteral calculi in the real world: Targeted education increases use and improves patient outcomes. J Urol. 2010;183:585–9) Peter Alken
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