Efficacy Of Medical Expulsive Therapy Research Articles

Medical Expulsive Therapy for Pediatric Ureteral Stones: A Meta-Analysis of Randomized Clinical Trials

To evaluate the efficacy and safety of medical expulsive therapy (MET) for ureteral stones in pediatric patients, Cochrane, PubMed, Web of Science, Scopus, and the reference list of retrieved studies were searched up to September 2022 to identify RCTs on the efficacy of MET. The protocol was prospectively registered at PROSPERO (CRD42022339093). Articles were reviewed, data were extracted by two reviewers, and the differences were resolved by the third reviewer. The risk of bias was assessed using the RoB2. The outcomes, including the stone expulsion rate (SER), stone expulsion time (SET), episode of pain, analgesic consumption, and adverse effects, were evaluated. Six RCTs enrolling 415 patients were included in the meta-analysis. The duration of MET ranged from 19 to 28 days. The investigated medications included tamsulosin, silodosin, and doxazosin. The stone-free rate after 4 weeks in the MET group was 1.42 times that of the control group (RR: 1.42; 95% CI: 1.26-1.61, p < 0.001). The stone expulsion time also decreased by an average of 5.18 days (95% CI: -8.46/-1.89, p = 0.002). Adverse effects were more commonly observed in the MET group (RR: 2.18; 95% CI: 1.28-3.69, p = 0.004). The subgroup analysis evaluating the influence of the type of medication, the stone size, and the age of patients failed to reveal any impact of the aforementioned factors on the stone expulsion rate or stone expulsion time. Alpha-blockers as medical expulsive therapy among pediatric patients are efficient and safe. They increase the stone expulsion rate and decrease the stone expulsion time; however, this included a higher rate of adverse effects, which include headache, dizziness, or nasal congestion.

Efficacy of medical expulsive therapy using the traditional Japanese medicine (kampo) choreito for the spontaneous passage of proximal ureteric stones: A retrospective analysis

AbstractAimUrolithiasis is a common disorder of the urinary tract. Medical expulsive therapy is recommended for calculi with diameters &lt;10 mm. This study was conducted to determine the effect of choreito, an herbal medication with discharging effects, on the spontaneous passage of urinary calculi.MethodsThis retrospective observational study included 109 adult patients with urinary calculi who were admitted to Hirao Hospital between April 2016 and March 2017. Choreito (7.5 g/day) was administered to 55 participants in the choreito group but not to the 54 participants of the control group. All patients were monitored until the calculi passed naturally. The period of spontaneous passage of the calculi was compared between the choreito and control groups, and the factors associated with this duration were identified using multivariate analysis.ResultsCompared to the control group, the period of spontaneous passage of the proximal ureteric stones was significantly shorter in the choreito group (14 days vs 36 days, p = 0.0262). Calculus diameter (&lt;3 mm) and choreito administration were identified as independent factors associated with a shorter period for spontaneous calculi passage.ConclusionOral administration of choreito may promote the spontaneous passage of proximal ureteric stones without the need for surgical intervention.

Comparison of the Efficacy of Medical Expulsive Therapy for the Treatment of Distal Ureteric Stones with and without Mirabegron

Comparison of the Efficacy of Medical Expulsive Therapy for the Treatment of Distal Ureteric Stones with and without Mirabegron

Efficacy of Medical Expulsive Therapy in Renal Calculi Less than or Equal to 5 Millimetres in Size.

Natural history and modality of treatment for asymptomatic renal calculi less than or equal to 5 millimetres in size is still unknown. Many options are available ranging from medical expulsive therapy to minimally invasive surgery. Till date no study has focussed on this very common but asymptomatic issue. Hence, this study is undertaken to evaluate efficacy of medical expulsive therapy in renal calculi less than or equal to 5mm in size. A prospective, parallel group, randomized study was carried out from 1st June 2014 to 31st May 2015, with total of 100 patients, 50 patients in each group. Patients with renal stones less than or equal to 5mm were included in the study. Group A Patients were administered medical expulsive therapy which included tamsulosin 0.4 mg daily at night time, furosemide 20mg, spironolactone 50mg in a single morning dose, and syrup potassium magnesium citrate 20Meq per dose three times a day for 12 weeks while group B patients were given placebo. The primary outcome variable was number of patients achieving clearance of stone during 12-week treatment period in both groups. No statistically significant differences in age, gender, stone size, and calyceal stone location was found between the two treatment arms. A spontaneous stone expulsion rate of 50% (at 6 weeks) and 86 %( at 12 weeks) was noted in group A versus 28% (at 6 weeks) and 38 % (at 12 weeks) in group B. Less number of pain episodes and less analgesic medication was required in group A as compared to group B. Medical Expulsive therapy for 12 weeks significantly improves stone free rates in renal calyceal calculi less than or equal to 5mm.

Medical Expulsive Therapy is Underused for the Management of Renal Colic in the Emergency Setting

Although the 2007 AUA (American Urological Association) guidelines established it as first line therapy for ureteral stones less than 10 mm, widespread adoption of medical expulsive therapy has been low. We determined the current penetrance of medical expulsive therapy guideline recommendations andthe efficacy of medical expulsive therapy in reducing the requirement for urological procedures after emergency department visits for ureteral stones. In a retrospective analysis of patients seen in the emergency department we included 2,105 emergency department visits associated with an ICD-9 diagnosis of urolithiasis in which computerized tomography abdomen/pelvis scan was performed. Outcomes were reviewed for spontaneous passage or required urological procedure. Ureteral stones were found in 48.8% of patients, including 50.0% in whom medical expulsive therapy was prescribed. There was no significant difference between patients who did and did not receive medical expulsive therapy. Within 12 weeks of the initial emergency department visit there was no difference in the rate of urological procedures performed in those who received medical expulsive therapy or in the rate of return to the emergency department. Patients treated with medical expulsive therapy experienced a shorter time to spontaneous expulsion (7.1 vs 12.8 days, p = 0.048). Medical expulsive therapy for renal colic in the emergency setting remains underused. Half of the patients who met criteria for medical expulsive therapy in this study did not receive the standard of care. Patients treated with medical expulsive therapy achieved spontaneous passage more quickly but there was no difference in the requirement for a urological procedure. These results highlight the need for personnel at emergency departments to better standardize care for patients with ureteral stones.

English

BACKGROUND: Medical expulsive therapy has been proven to enhance stone expulsion rate, decrease stone expulsion time and decrease the use of analgesics in lower ureteric calculus. But adequate data is not available on the efficacy of medical expulsive therapy for mid ureteric calculus. Tamsulosin is the most common agent used in medical expulsive therapy along with analgesics. Hence we have studied the efficacy of medical expulsive therapy in this study. PURPOSE: To determine the efficacy of medical expulsive therapy in mid ureteric calculi of up to 10 mm in size- Comparing the results with Placebo and lower ureteric calculi. MATERIAL AND METHODS: It was a prospective randomized study conducted between September 2011 to march 2013. 60 patients with mid ureteric calculi of ≤10 mm and 60 patients with lower ureteric calculi of ≤10 mm were randomly selected for the study. Patients in the study group received 0.4 mg of Tamsulosin and Aceclofenac 100 mg SOS, whereas the control group received only analgesics. Statistical methods used: All the data was collected and analyzed using SPSS 16.0 (2007) software. RESULTS: The stone expulsion rate was higher for patients with mid ureteric calculi who received medical expulsive therapy compared to controls (56.6% Vs. 20%). The stone expulsion rate was higher for patients with lower ureteric calculi compared to patients with mid ureteric calculi (93.3% Vs. 56.6%). CONCLUSION: Medical expulsive therapy can be used with success in patients with mid ureteric calculi up to 10 mm in size. Medical expulsive therapy is more beneficial in patients with lower ureteric calculi as compared to patients with mid ureteric calculi.

2256 MEDICAL EXPULSIVE THERAPY UTILIZATION IN PATIENTS PRESENTING WITH URETEROLITHIASIS

You have accessJournal of UrologyStone Disease: Evaluation & Medical Management (II)1 Apr 20132256 MEDICAL EXPULSIVE THERAPY UTILIZATION IN PATIENTS PRESENTING WITH URETEROLITHIASIS Aaron Lay, Jeffrey Leow, Benjamin Chung, and Steven Chang Aaron LayAaron Lay Boston, MA More articles by this author , Jeffrey LeowJeffrey Leow Boston, MA More articles by this author , Benjamin ChungBenjamin Chung Stanford, CA More articles by this author , and Steven ChangSteven Chang Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2165AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Randomized controlled trials have demonstrated the efficacy of medical expulsive therapy (MET) for promoting passage of ureteral stones. Though this is well known among urologists, there has been concern regarding its utilization in the acute setting, when these patients may not be treated by urologists. We sought to measure utilization rates of MET in patients presenting with acute ureterolithiasis. METHODS We captured all patients who had a primary diagnosis of ureterolithiasis between January 1, 2003, and December 31, 2010, based on ICD-9 code 592.1 from Premier Perspective Database (Premier Inc, Charlotte, NC), a nationally representative discharge database that covers 20% of US hospital discharges. Patients who carried diagnosis of ureterolithiasis but did not undergo a surgical procedure were included in the study. Patients who received tamsulosin, nifedipine, and/or predisone were identified by hospital charge billing descriptions. Statistical analyses were performed using STATA. All statistical testing was two-sided and a p-value<0.05 was considered statistically significant. RESULTS There were 2916 patients who had a principal diagnosis of ureterolithiasis but did not undergo a surgical procedure. Patients received tamsulosin 12.4% of the time, while nifedipine use was 1.5% and steroid use was 2.8%. Tamsulosin was more likely used in men, in teaching hospitals, and in recent years. Tamsulosin was also more likely used in the Middle Atlantic States compared to other regions of the country. CONCLUSIONS Even though there are randomized controlled trials that have demonstrated medical expulsive therapy to increase the likelihood of stone passage and faster time to stone passage, MET is underutilized. Our analysis suggests that MET is being used more frequently in recent years, but there is still underuse in the medical community. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e925 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Lay Boston, MA More articles by this author Jeffrey Leow Boston, MA More articles by this author Benjamin Chung Stanford, CA More articles by this author Steven Chang Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Randomized controlled trial of the efficacy of isosorbide-SR addition to current treatment in medical expulsive therapy for ureteral calculi

It has been suggested that nitrates are potent smooth muscle relaxants that may reduce pain and facilitate ureteral stone passage; therefore it may be an option for medical expulsive therapy in ureteral stones. In a prospective randomized controlled clinical trial, we evaluated the efficacy of medical expulsive therapy with isosorbide-SR 40 mg in patients with ureteral stones (≤10 mm). The patients with ureteral stones in KUB or urinary tract ultrasonography were randomized to receive methylprednisolone plus celecoxib without (control group), and with isosorbide-SR 40 mg (treatment group) for 21 days. 66 patients [33(50%) in control, 33(50%) in treatment group] were entered randomly to our study. The stone expulsion rate was not significantly different between two groups (54.5 vs. 45.5%) (P = 0.497). The need for surgical procedures were more common in control group within 21 days (9.4 vs. 6.1%) and more common in treatment group after 21 days (33.3 vs. 21.9%) (P = 0.756).Patients in the treatment group experienced more intractable pain (27.3 vs. 6.1%), intractable vomiting (3 vs. 0%) (P = 0.046) and hospitalization (3 vs. 0%) (P = 0.314). Drug side effects including headache and dizziness were more common in treatment group (39.4 vs. 9.1%) (P = 0.004). In our study, the use of isosorbide-SR in treatment group did not improve the stone expulsion rate in patients with ureteral stones (≤10 mm) but developed more side effects. Then it may not an appropriate alternative for medical expulsive therapy. Of course, further trials are recommended.

Editorial Comment

In this investigation, the authors report the frequency of use of medical expulsive therapy (MET) in patients diagnosed with acute renal colic in emergency departments in the United States. This information is obtained from an annually updated government-sponsored database containing a systematic random sample of physician reported data on patient presenting complaints, diagnoses, and medications orders. The use of MET doubled yearly from 2000 through 2006; however, average use over the period was very low at 1.1% and peak use in 2006 was only 3.9%. Given the evidence that MET spares 1 in 4 patients from the need for surgical intervention, this low usage was unable to save significant patient suffering and health system expense. Despite some limitations of the study that may overestimate the eligible population, the fact remains that a large number of patients who could have benefited from MET did not have it prescribed. Trends in Medical Expulsive Therapy Use for Urinary Stone Disease in U.S. Emergency DepartmentsUrologyVol. 74Issue 6PreviewBetween 2000 and 2006, 11 randomized controlled trials were published, demonstrating the efficacy of medical expulsive therapy (MET) for promoting upper tract stone passage. Although its use is gaining traction among urologists, they evaluate a minority of patients who present to the emergency department (ED) for acute renal colic before discharge. As such, measuring the uptake of MET into the broader medical community is important. Full-Text PDF

Trends in Medical Expulsive Therapy Use for Urinary Stone Disease in U.S. Emergency Departments

Between 2000 and 2006, 11 randomized controlled trials were published, demonstrating the efficacy of medical expulsive therapy (MET) for promoting upper tract stone passage. Although its use is gaining traction among urologists, they evaluate a minority of patients who present to the emergency department (ED) for acute renal colic before discharge. As such, measuring the uptake of MET into the broader medical community is important. Data were analyzed (2000-2006) from the National Hospital Ambulatory Medical Care Survey. Sampled ED visits for stones were identified. The use of MET was ascertained by the prescription of a calcium channel or alpha blocker at the ED visit. National estimates of the prevalence of MET use were computed. Logistic regression was used to examine linear and nonlinear time trends in MET prescription. The use of MET increased throughout the study period. In fact, the odds of being treated with this approach more than doubled with each successive year (OR, 2.15; 95% CI, 1.31-3.5; P < .001 for the linear trend). However, the overall prevalence of use was exceedingly low at 1.1% (95% CI, 0.6%-1.9%). Given the number needed to treat of 4, this implies a missed opportunity to spare approximately 260,000 individuals annually from stone surgery and its risks. Despite the growing body of evidence to support its safety and efficacy, our analysis reveals the sluggish dissemination of MET into the broader medical community. The observed underuse represents a block in the translation of clinical science into practice and raises a quality of care concern.

Is There a Role for Tamsulosin in the Treatment of Distal Ureteral Stones of 7 mm or Less? Results of a Randomised, Double-Blind, Placebo-Controlled Trial

BackgroundNumerous randomised trials have confirmed the efficacy of medical expulsive therapy with tamsulosin in patients with distal ureteral stones; however, to date, no randomised, double-blind, placebo-controlled trials have been performed. ObjectiveThe objective of this trial was to evaluate the efficacy of medical expulsive therapy with tamsulosin in a randomised, double-blind, placebo-controlled setting. Design, setting, and participantsPatients presenting with single distal ureteral stones ≤7mm were included in this trial. InterventionPatients were randomised in a double-blind fashion to receive either tamsulosin or placebo for 21 d. The medication was discontinued after either stone expulsion or intervention. Abdominal computed tomography was performed to assess the initial and final stone status. Measurements and limitationsThe primary end point was the stone expulsion rate. Secondary end points were time to stone passage, the amount of analgesic required, the maximum daily pain score, safety of the therapy, and the intervention rate. ResultsTen of 100 randomised patients were excluded from the analysis. No statistically significant differences in patient characteristics and stone size (median: 4.1mm [tamsulosin arm] vs 3.8mm [placebo arm], p=0.3) were found between the two treatment arms. The stone expulsion rate was not significantly different between the tamsulosin arm (86.7%) and the placebo arm (88.9%; p=1.0). Median time to stone passage was 7 d in the tamsulosin arm and 10 d in the placebo arm (log-rank test, p=0.36). Patients in the tamsulosin arm required significantly fewer analgesics than patients in the placebo arm (median: 3 vs 7, p=0.011). A caveat is that the exact time of stone passage was missing for 29 patients. ConclusionsTamsulosin treatment does not improve the stone expulsion rate in patients with distal ureteral stones ≤7mm. Nevertheless, patients may benefit from a supportive analgesic effect. Clinicaltrials.govNCT00831701.

Medical Therapy of Urolithiasis

Nephrolithiasis treatment has become easier and less invasive with the development of extracorporeal shockwave lithotripsy (SWL) and endourologic techniques. However, medical therapy represents a well-established and complementary approach that can improve the efficacy of SWL and endourology. During recent decades, pharmacologic intervention has become more effective in stone disease: drugs can control the pain of renal colic, interfere at various levels in lithogenesis, and contribute to the expulsion of stones. It is well known that lithogenesis is a multifactorial process influenced by environmental-nutritional factors (low urinary volume, diet rich in animal protein, etc) and metabolic alterations; i.e., hypercalciuria, hyperuricosuria, and deficiency of stone-inhibiting factors (citrate, magnesium, glycosaminoglycans [GAGs]). Specific drugs such as citrate, allopurinol, and thiazide represent highly effective treatments for the promoting factors. Furthermore, recent findings suggest an interesting role for a phytotherapeutic agent, Phillantus niruri, and its inhibitory action on calcium oxalate crystallization related to the higher incorporation of GAGs into the calculi. Another step forward in medical management of stone disease is expulsive therapy. Many studies have proven the efficacy of medical expulsive therapy with nifedipine and alpha-blockers: their specific action on ureteral smooth muscle in association with anti-edema drugs accounts for their efficacy in expelling ureteral stones. In this paper, we provide an update on the medical treatment of stone disease, focusing our attention on what is known and what is new in renal colic and litholithic and expulsive medical therapy.