Predictive parameters for medical expulsive therapy in ureteral stones: a critical evaluation

Abstract

To evaluate the predictive value of some certain radiological as well as stone-related parameters for medical expulsive therapy (MET) success with an alpha blocker in ureteral stones. A total 129 patients receiving MET for 5 to 10 mm ureteral stones were evaluated. Patients were divided into two subgroups where MET was successful in 64 cases (49.61%) and unsuccessful in 65 cases (50.39%). Prior to management, stone size, location, position in the ureter, degree of hydronephrosis, diameter of ureteral lumen proximal to the stone, ureteral wall thickness along with patient's demographics including body mass index (BMI) values were evaluated and recorded. The possible predictive values of these parameters for stone expulsion (and stone expulsion time) were evaluated in a comparative manner between two groups. The overall mean patient age and stone size values were 38.02 ± 0.94 years and 40.31 ± 1.13 mm(2), respectively. Regarding the predictive values of these parameters for MET-success, while stone size and localization, degree of hydronephrosis, proximal ureteral diameter and ureteral wall thickness were found to be highly predictive for MET-success, patients age, BMI values and stone density had no predictive value on this aspect. Our findings indicated that some stone and anatomical factors may be used to predict the success of MET in an effective manner. With this approach unnecessary use of these drugs that may cause a delay for stone removal will be avoided and the possible adverse effects of obstruction as well as stone-related clinical symptoms could be minimized.

Computed tomography findings predicting the success of silodosin for medical expulsive therapy of ureteral stones

“…The final report of the study was that HU is not a predictive parameter for stone expulsion [19]. In another study showing that stone size and localization, hydronephrosis grade, proximal ureteral diameter and ureteral wall thickness were highly associated with MET success rates, stone density was not shown to be associated with MET success [20]. However in this study, we determined that stone related factors on NCCT images such as stone diameter, volume and HU predicted stone expulsion rate at the end of 6 weeks of silodosin treatment for distal, mid and proximal ureteral stones with univariate analysis.…”

The role of Silodosin as a new medical expulsive therapy for ureteral stones: a meta-analysis

“…It is reported that stone size and location are important parameters for predicting MET-success. 31 The definitive management of stones in these patients is usually deferred because approximately 68%-98% of stones <5 mm are expected to pass spontaneously. 32,33 As stone size increases, however, spontaneous passage becomes less likely; 34,35 the estimated spontaneous passage rate is 47% for stones >5 mm and <10 mm.…”

Impaction and Prediction: Does Ureteral Wall Thickness Affect the Success of Medical Expulsive Therapy in Pediatric Ureteral Stones?

“…In other words, ureteral stone(s) staying in the same position for a long period of time will impact into the ureteral wall (embed itself into the ureteric wall) due to inflammatory reaction-induced tissue changes in this part of the ureter. Additionally, the possible effect of UWT at the site of the stone as a predictive factor for final stone expulsion rates after MET has been evaluated in a recently published study, and UWT has been found to be a reliable predictor parameter [42] . Moreover, in their original study, Sarica et al [43] were able to show the predictive value of UWT on the SFR as well as additional procedure rates after SWL in ureteric stones with a cutoff value 3.55 mm over which additional procedure rates were found to be meaningfully high.…”