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Breathing-controlled Electrical Stimulation BreEStim for Management of Neuropathic Pain and Spasticity
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Medical Expulsive Therapy: Worthwhile or Wishful Thinking.

Tad Kroczak1, Kenneth T Pace1, Jason Y Lee2

  • 1St Michael's Hospital, University of Toronto, 61 Queen St E - suite 2-012, Toronto, Ontario, M5C 2T2, Canada.

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Summary

Medical expulsive therapy (MET) shows no benefit for preventing secondary interventions in a large trial. However, alpha-blockers may aid passage of larger ureteric calculi, reducing pain and need for surgery.

Keywords:
Alpha-blockersMedical expulsive therapyUrolithiasis

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Area of Science:

  • Urology
  • Pharmacology

Background:

  • Conflicting evidence exists regarding the efficacy of medical expulsive therapy (MET).
  • Recent high-level evidence presents a complex picture of MET's benefits.

Purpose of the Study:

  • To provide an overview of the most recent evidence for medical expulsive therapy (MET).

Main Methods:

  • Review of recent literature, including a large double-blind randomized control trial and meta-analyses of randomized trials.
  • Analysis of guidelines from major urological organizations.

Main Results:

  • A large trial found no benefit of MET (tamsulosin, nifedipine) in preventing secondary interventions.
  • Meta-analysis suggests alpha-blockers may shorten passage time, reduce pain, and decrease surgical intervention for larger ureteric calculi (≥5 mm).
  • Major urological associations recommend MET for conservative management of ureteric calculi.

Conclusions:

  • MET is a reasonable option for conservative management of ureteric calculi, potentially avoiding surgery.
  • Greatest benefit likely with alpha-blockers for larger distal ureteric stones.
  • MET may aid stone fragment clearance post-SWL and appears safe in pregnant and pediatric patients.