Medical expulsive therapy for ureteric calculi – yes or no?

Abstract

In recent years, there has been a potential paradigm shift in the conservative management of ureteric calculi away from the routine use of medical expulsive therapy (MET). A large body of evidence exists to hopefully answer this common clinical question. Multiple meta-analyses have been performed in the last decade to evaluate the existing evidence. Most, if not all have demonstrated benefit of administering MET for patients with ureteric calculi. In more recent years, the publication of several good quality, randomised controlled studies has cast doubt over the routine use of MET in these patients. These recent studies suggest that MET has no benefit in the conservative management of patients with ureteric calculi. In this article, we aim to provide a pragmatic commentary on the evidence to date and highlight the arguments both for and against the routine use of MET. We aim to highlight the steps that our unit has taken in translating good quality medical research into day-to-day clinical practice and also, to demonstrate our department’s current practice and the rationale behind it.