Current use of medical expulsive therapy among endourologists

We aimed to characterize current practice patterns among endourologists on medical expulsive therapy (MET) for treatment of ureteral calculi.

An online survey was administered to Endourological Society members. Respondents' MET usage, index case management, and awareness of recent guidelines and literature were compared based on international status, practice setting, interval since training, and endourological fellowship training.

Of the 237 complete responses, 65% were international, 61% were academic, 66% had >10 years in practice, and 71% were endourology fellowship-trained. MET was used by 88%, with no differences between international, academic, practice length, and fellowship-trained groups. MET was used more frequently for <8 mm and distal stones and more U.S.-based respondents reported use for proximal/midureteral stones (68% vs 43%; p<0.001). For the index patient, 70% preferred MET as the initial approach and respondents <10 years from training were more likely to choose MET (82% vs. 64%; p=0.006). While 82% of respondents were aware of the SUSPEND trial, 70% reported that it had not altered their use of MET. Current American Urological Association (AUA) guideline awareness was 90%. Mean MET prescription length was 19.9±10.3 days, and was statistically significantly longer for respondents who were U.S.-based, academic and <10 years from training.

MET is the preferred approach for patients with ureteral calculi <10 mm among endourologists despite conflicting data in the literature. While current AUA practice guidelines are followed by the majority of respondents, our survey suggests MET is being used more liberally than the guideline criteria, specifically in proximal and midureteral stones.