Myth: Nephrolithiasis and medical expulsive therapy

Abstract

There is a medical myth that ureteral stones larger than 5 mm will not pass spontaneously and require urological intervention for removal. Recent findings indicate that medical expulsive therapy can facilitate spontaneous passage for stones up to 10 mm. For the management of ureteral stones, we recommend administering tamsulosin and a corticosteroid (deflazacort or prednisone) along with the standard therapy of analgesics, antibiotics and hydration. RÉSUMÉSelon un mythe médical, les calculs urétéraux de plus de 5 mm ne pourraient pas passer spontané-ment et nécessiteraient une intervention urologique. Des études récentes montrent cependant qu'un traitement expulsif peut faciliter le passage spontané de calculs de 10 mm ou moins. Nous recommandons, pour la prise en charge de calculs urétéraux, l'administration de la tamsulosine et de corticostéroïdes (deflazacort ou prednisone) en combinaison avec un traitement standard d'analgésiques, d'antibiotiques et d'hydratation.

Management of ureteral calculi and medical expulsive therapy in emergency departments

“…Calcium-channel blockers, by modifying the effect of calcium on smooth muscle cells of the ureter, have been proposed to decrease ureteral contractions and, subsequently, the pain of ureteral colic. [526] The ureter contains both alpha- and beta-adrenergic receptors. Antagonists of the alpha-1-adrenergic receptor, in particular, inhibit basal tone and decrease peristaltic frequency and amplitude with the consequences of increased fluid transport and decreased intra-ureteral pressure; they also block the conduction of visceral referred pain to the central nervous system, acting on C-fibres or sympathetic postganglionic neurons.…”

“…The most frequently used anti-inflammatory drugs in this context are corticosteroids, which are given in association with alpha-1-adrenergic receptor antagonists and calcium-channel blockers because of their action of decreasing edema and inflammation and, thereby, relieving an obstacle to the passage of the stone. [2630–32] Corticosteroids should, however, only be used for short periods in order to avoid the many adverse effects associated with prolonged therapy. [33] The role of corticosteroid therapy alone has not been investigated.…”

Role of steroidal anti-inflammatory agent prior to intracorporeal lithotripsy under local anesthesia for ureterovesical junction calculus: A prospective randomized controlled study

“…Investigators have shown that larger stones tend to cause more intense inflammatory reactions leading to edema. [ 5 ] Corticosteroids stabilize neutrophil lysosomes, therefore, decreasing inflammation and edema related to mechanical irritation. [ 6 7 ] Here, we have administered 30 mg of deflazacort for 10 days.…”

“…The majority of the authors recommended not to use for more than 10 days to prevent the side effects of prolonged use. [ 5 8 9 10 ] In our clinical practice, we are not routinely using deflazacort for MET because of its high cost and also as it limit the duration of MET. In the present study, we observed that the inflamed ureteric orifice appears as prominent soft tissue swelling on CT scan [ Figure 4 ].…”

Medical Expulsive Therapy in Acute Colic are We Justified?

“…Moreover MET cannot be given for a prolonged period. May et al [4] had suggested that any MET should not be indiscriminately given beyond 4 weeks, as continuous treatment with MET would cause renal dysfunction, further pain and probably urosepsis.…”