@article{3121845,
    title = "Medical Expulsive Therapy for Urinary Stones: Future Trends and Knowledge Gaps",
    author = "De Coninck, V. and Antonelli, J. and Chew, B. and Patterson, J.M. and Skolarikos, A. and Bultitude, M.",
    journal = "European urology oncology",
    year = "2019",
    volume = "76",
    number = "5",
    pages = "658-666",
    publisher = "Elsevier B.V.",
    doi = "10.1016/j.eururo.2019.07.053",
    keywords = "alpha adrenergic receptor blocking agent;  calcium channel blocking agent;  corticosteroid;  phosphodiesterase V inhibitor, drug therapy;  extracorporeal shock wave lithotripsy;  human;  meta analysis;  meta analysis (topic);  practice guideline;  priority journal;  randomized controlled trial (topic);  Review;  systematic review;  ureter stone;  clinical trial (topic);  disease management;  patient selection;  ureter stone, Clinical Trials as Topic;  Disease Management;  Humans;  Outcome Assessment, Health Care;  Patient Selection;  Ureteral Calculi",
    abstract = "Context: Medical expulsive therapy (MET) for ureteral stones has become a controversial area due to the contradictory results of high-quality trials and meta-analyses. Objective: We aimed to review the literature to evaluate the value of and future directions for MET for ureteral stone disease. Evidence acquisition: A literature search of the MEDLINE database and the Cochrane Library was conducted to collect articles about MET for ureteral calculi published up to 28 October 2018. A total of 524 articles were screened. Sixty-nine publications that met the inclusion criteria for this review were chosen. Among the primary research articles on MET with stone clearance as the primary outcome, seven responded to high-quality requirements of Cochrane Collaboration's tool for assessing the risk of bias in randomised trials. Evidence synthesis: The vast majority of randomised, double-blind, placebo-controlled trials without a high or an unclear risk of bias did not find a benefit of MET for increased ureteral stone passage rates. This is in contrast to results of meta-analyses that are skewed by low-quality trials. Conclusions: The strength of evidence for the benefit of MET in ureteral stones is low, even for distal ureteral stones >5 mm. In the absence of further high-quality data, individual clinicians are required to decide for themselves whether to believe high-quality single trials or meta-analyses. Patient summary: We evaluated the value of and future directions for medical expulsive therapy (MET) for ureteral stone disease. We found that outcomes varied between studies. Individual clinicians are required to decide for themselves which studies to believe. Alpha-blockers as MET may retain a role in a selective group of well-counselled patients with larger stones who understand the side effects and off-label use. © 2019 European Association of Urology
The strength of evidence for the benefit of medical expulsive therapy in ureteral stones is low, even for distal ureteral stones >5 mm. © 2019 European Association of Urology"
}