title: Medical expulsive therapy for distal ureteral stones.
abstract: Although minimally invasive treatments for ureteral stones are efficacious, they are not free of complications and are associated with high cost. Medical expulsive therapy (MET) has recently emerged as an alternative strategy for the initial management of small distal ureteral stones. A MEDLINE search was undertaken to evaluate all currently available data on efficacy and safety of MET therapy in such patients. The specific mechanism of action on the ureteral smooth muscle and the emerging evidence of the efficacy (defined as either an increase in expulsion rate or a decrease in time to expulsion) and low-risk profile suggest that alpha-adrenergic receptor antagonists (alpha-blockers) and calcium channel antagonists should be the initial medical treatment in patients amenable to conservative therapy. NSAIDs and anticholinergics have not shown efficacy as single agents or in combination with alpha-blockers or nifedipine. Corticosteroids may provide a small additive effect when combined with either alpha-blockers or nifedipine.
authors.affiliation: Department of Urology, University of Thessaly School of Medicine, Larissa, Greece.
authors.forename: Vassilios
authors.initials: V
authors.lastname: Tzortzis
authors.forename: Charalampos
authors.initials: C
authors.lastname: Mamoulakis
authors.forename: Jorge
authors.initials: J
authors.lastname: Rioja
authors.forename: Stavros
authors.initials: S
authors.lastname: Gravas
authors.forename: Martin C
authors.initials: MC
authors.lastname: Michel
authors.forename: Jean J M C H
authors.initials: JJ
authors.lastname: de la Rosette
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D006801:Humans; D014514:Ureteral Calculi / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology
chemical_list: D000305:Adrenal Cortex Hormones; D000317:Adrenergic alpha-Antagonists; D000894:Anti-Inflammatory Agents, Non-Steroidal; D002121:Calcium Channel Blockers; D018680:Cholinergic Antagonists