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Myth: Nephrolithiasis and medical expulsive therapy

Published online by Cambridge University Press:  21 May 2015

May Liu
Affiliation:
Department of Emergency Medicine, University of Southern California, Los Angeles, Calif.
Sean O. Henderson*
Affiliation:
Department of Emergency Medicine, University of Southern California, Los Angeles, Calif. Department of Preventive Medicine Keck School of Medicine, University of Southern California, Los Angeles, Calif.
*
Department of Emergency Medicine, LAC+USC Medical Center, Unit #1, Rm. 1011, 1200 N. State St., Los Angeles CA 90033; [email protected]

Abstract

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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.

Type
Knowledge Applied to Practice Application des connaissances à la Pratique
Copyright
Copyright © Canadian Association of Emergency Physicians 2007

References

References:

1.Brown, J. Diagnostic and treatment patterns for renal colic in US emergency departments. Int Urol Nephrol 2006;38:8792.Google Scholar
2.Marx, J, Hockberger, R, Walls, R, et al. Rosen’s emergency medicine concepts and clinical practices. Philadelphia: Mosby Inc.; 2006.Google Scholar
3.Sur, R, Marguet, C, Priminger, G. Management of ureteral calculi. AUA Update 2006;25:161–71.Google Scholar
4.Cooper, J, Stack, G, Cooper, T. Intensive medical management of ureteral calculi. Urology 2000;56:575–8.CrossRefGoogle ScholarPubMed
5.Porpiglia, F, Destefanis, P, Fiori, C, et al. Effectiveness of nifedipine and deflazacort in the management of distal ureter stones. Urology 2000;56:579–82.CrossRefGoogle ScholarPubMed
6.Dellabella, M, Milanese, G, Muzzonigro, G. Efficacy of tamsulosin in the medical management of juxtavescial ureteral stones. J Urol 2003;170:2202–5.Google Scholar
7.Troxel, S, Jones, A, Magliola, L, et al. Physiologic effect of nefedipine and tamsulosin on contractility of distal ureter. J Endourol 2006;20:565–8.CrossRefGoogle Scholar
8.Dellabella, M, Milanese, G, Muzzonigro, G. Randomized trial of the efficacy of tamsulosin, nifedipine, and phloroglucinol in medical expulsive therapy for distal ureteral calculi. J Urol 2005;174:167–72.CrossRefGoogle ScholarPubMed
9.Cervenàkov, I, Fillo, J, Mardiak, J, et al. Speedy elimination of ureterolithiasis in lower part of ureters with the alpha 1-blockers tamsulosin. Int Urol Nephrol 2002;34:25–9.Google Scholar
10.Borghi, L, Meschi, T, Amato, F, et al. Nifedipine and methylpred nisolone in facilitating ureteral stone passage: a randomized, double-blind, placebo-controlled study. J Urol 1994;152:1095–8.Google Scholar
11.Yilmaz, E, Batislam, E, Basar, M, et al. The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones. J Urol 2005;173:2010–2.Google Scholar
12.De Sio, M, Autorino, R, Di Lorenzo, G, et al. Medical expulsive treatment of distal-ureteral stones using tamsolusin: a singlecenter experience. J Endourol 2006;20:12–6.CrossRefGoogle Scholar
13.Yamaguchi, K, Minei, S, Yamazachi, T, et al. Characterization of ureteral lesions associated with impacted stones. Int J Urol 1999;6:281–5.CrossRefGoogle ScholarPubMed
14.Holmlund, D, Hassler, O. A method of studying the ureteral reaction to artificial concrements. Acta Chir Scand 1965;130:335–43.Google Scholar
15.Saita, A, Bonaccorsi, A, Marchese, F, et al. Our experience with nifedipine and prednisolone as expulsive therapy for ureteral stones. Urol Int 2004;72(Suppl 1):43–5.CrossRefGoogle ScholarPubMed
16.Dellabella, M, Milanese, G, Muzzonigro, G. Medical-expulsive therapy for distal ureterolithiasis: randomized prospective study on role of corticosteroids used in combination with tamsulosin-simplified treatment regimen and health-related quality of life. J Urol 2005;66:712–5.Google Scholar
17.Porpiglia, F, Ghignone, G, Fiori, C, et al. Nifedipine versus tamsulosin for the management of power ureteral stones. J Urol 2004;172:568–71.Google Scholar
18.Hubner, W, Irby, P, Stoller, M. Natural history and current concept for the treatment of small ureteral calculi. Eur Urol 1993;24:172–6.CrossRefGoogle ScholarPubMed