The Use of Medical Expulsive Therapy During Pregnancy: A Worldwide Perspective Among Experts.
BACKGROUND
Medical expulsive therapy (MET) is a pharmacologic approach thought to augment the spontaneous passage of ureteral calculi. The usage of MET pharmacologics for presumed ureteral calculi during pregnancy has not been studied and their safety and utility are unknown. We sought to characterize the worldwide usage of MET in the setting of pregnancy with presumed ureteral calculus (P-MET), as well as factors associated with physician use. Experts in stone management were specifically sought.


METHODS
A nine-question survey was delivered through society-administered e-mail. Questions gathered physician's worldwide region, degree of specialization in stone disease, practice type, interval since training, and willingness to use both MET and P-MET. We assessed drugs of choice in those using P-MET and reasons for avoidance in non-P-MET users. Finally, we assessed the impact of physician-perceived medicolegal risk on usage of P-MET.


RESULTS
Five hundred sixty-five responses were recorded. Sixty-three percent were US-based practitioners and the remaining represented a worldwide distribution. Worldwide usage of MET was 97.6%, and tamsulosin was globally preferred by over 90% of urologists. P-MET was endorsed by only 44.3%. 23.6% of European practitioners used this strategy compared with 51.1% of US physicians. Time from training and practice type did not significantly interact with adoption of P-MET; experts were less likely to use P-MET. Physician nonuse of MET during pregnancy was adverse outcome related: 76.7% reported either the fear of legal risk (52.8%) or concerns about safety (23.9%).


CONCLUSIONS
Respondents report impressive worldwide adoption of MET. P-MET is less trusted, and fears of legal risk and safety far outweigh questions about effectiveness. The effectiveness of drugs during pregnancy-induced ureteral dilation is unknown. Still, 44% of global respondents embrace usage of this drug strategy despite a paucity of evidence supporting either safety or effectiveness during pregnancy.
1 Department of Urology, University of Wisconsin , Madison, Wisconsin.
Granville L
GL
Lloyd
1 Department of Urology, University of Wisconsin , Madison, Wisconsin.
Amy
A
Lim
2 Department of Urology, Feinberg School of Medicine , Chicago, Illinois.
Nabeel
N
Hamoui
1 Department of Urology, University of Wisconsin , Madison, Wisconsin.
Stephen Y
SY
Nakada
2 Department of Urology, Feinberg School of Medicine , Chicago, Illinois.
Stephanie J
SJ
Kielb
D005260:Female; D006801:Humans; D016365:Liability, Legal; D008318:Malpractice; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D018570:Risk Assessment; D012449:Safety; D013038:Specialization; D013449:Sulfonamides / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D000077409:Tamsulosin; D014514:Ureteral Calculi / Q000188:drug therapy*; D064804:Urological Agents / Q000627:therapeutic use*
D013449:Sulfonamides; D064804:Urological Agents; D000077409:Tamsulosin