Would you recommend medical expulsive therapy in patients with ureteral stones?
Runólfur Pálsson, MD: Internists and nephrologists have a lot to offer for patients with recurrent stone disease because we have ways to prevent stone formation.
With respect to the acute stone event, the ureteral stone, I believe that the evidence for medical expulsive therapy is weak. We have, obviously, alpha blockers, tamsulosin. But the treatment is risky in the sense that you have to keep a close eye on the patient. There is a risk of urinary tract infection, and because there is an obstruction in the ureter, there is a risk of hydronephrosis and so on. So the question is for how long you are going to administer this therapy.
In my opinion, you can try this therapy if you think that there is a good chance of a stone passing down the ureter, but you have to monitor the patient carefully. I believe [it is better to] resort to stone extraction therapy using endourologic procedures or even lithotripsy sooner rather than later.