Nonsurgical management of urolithiasis: an overview of expulsive therapy

Although minimally invasive stone therapies such as shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy are efficacious, these techniques are not free of risks and are relatively expensive. Watchful waiting may be appropriate in patients without infection whose pain can be controlled with oral medication but is associated with pain, uncertainty, potential risks to renal function, and time lost from work. Hydroxyprogesterone, prostaglandin synthetase inhibitors, calcium-channel blockers such as nifedipine, alpha-1 blockers such as tamsulosin, and corticosteroids may have some beneficial effect. Future studies are likely to provide additional data in support of their use.