Evolving Guidance on Ureteric Calculi Management in the Acute Setting

Area of Science:

• Urology
• Emergency Medicine
• Radiology

Background:

• Ureteric colic is a frequent emergency department presentation.
• Non-contrast CT of the kidneys, ureters, and bladder (CT KUB) is the gold standard for diagnosis.
• Non-steroidal anti-inflammatory drugs (NSAIDs) are first-line analgesia; steroids and phosphodiesterase-5 inhibitors lack evidence.
• High body mass index (BMI) is an emerging risk factor.

Purpose of the Study:

• To evaluate the efficacy of medical expulsive therapy (MET) for facilitating spontaneous ureteric stone passage.
• To assess the role of alpha-blockers, specifically tamsulosin and nifedipine, in managing ureteric stones.

Main Methods:

• The Spontaneous Urinary Stone Passage Enabled by Drugs (SUSPEND) trial was conducted.
• The trial compared MET (tamsulosin and nifedipine) against a placebo.
• Participants presented with acute ureteric colic.

Main Results:

• The SUSPEND trial demonstrated no significant difference between MET and placebo in achieving spontaneous passage of ureteric stones.
• NSAIDs remain the recommended first-line analgesia.
• Primary ureteroscopy is gaining traction for non-infective ureteric stones.

Conclusions:

• Medical expulsive therapy (MET) does not improve spontaneous ureteric stone passage rates compared to placebo.
• Management strategies for ureteric colic should focus on NSAIDs and consider ureteroscopy for specific cases.
• Further research into risk factors like high BMI may inform prevention and treatment.