Optimal Duration of Medical Expulsive Therapy for Lower Ureteral Stones : a Critical Evaluation

Abstract

Abstract Aim To evaluate optimal duration of Medical Expulsive Therapy (MET) application for distal ureteric stones on a time period based manner. Patients and Methods : 89 patients with 5–10 mm distal ureter stones received tamsulosin (0.4 mg) for MET and diclofenac sodium (75 mg) for analgesia. Patients were evaluated once a week for four weeks. Radiologic evaluation of stone passage was evaluated by kidney ureter bladder (KUB) and ultasonography where non-contrast computed tomography (NCCT) was also performed if needed. Results While 23 cases (28.4%) were SF after first week, 23 were SF (28.4%) after two weeks, 9 cases (11.1%) after three and lastly 7 cases (8.6%) became SF after four weeks. 19 (23.5%) cases were not SF after 4 weeks. A positive relationship was found between the time period elapsed for stone passage and ureteral wall thickness (UWT) along with hydronephrosis. Additionally, mean number of renal colics and emergency department (ED) visits were found to be higher in patients passing their stones in the 4th week along with the ones who could not pass their stones. Conclusions Following the initiation of MET, SFR were higher in the first three weeks for distal ureteric stones for sizing 5–10 mm. indicating that waiting for a longer period of time will result in an unnecessary analgesic and MET treatment with increased risk of emergency department visits, additional costs and loss of time. Other available treatment options could be considered in such cases who are not SF at the end of the first three weeks.