Medical Expulsive Therapy (MET) for Large Distal Ureteral Stones: A Prospective Study Comparing Three Drugs

Abstract

Introduction: One of the most common disorders of the urinary tract is Urolithiasis. Twenty percent of lithiasis are located in the ureter of which 68% are seen in the distal ureter. The concept of medical expulsive therapy (MET) has been developed with enough knowledge of the ureter physiology in order to make easier the spontaneous expulsion of the stone. The aim of this study was to evaluate the efficacy and safety of three different drugs for the treatment of pelvic ureteral stones. Materiel and Methods: Between October 2017 and November 2018, 90 adult patients presenting with low or non-obstructive pelvic ureteral stones sized 8 to 10 mm were included. They were prospectively randomized, using computer-based randomization charts, into three equal groups: treatment with ketoprofen 100 mg once daily (Group I), silodosin 8 mg once daily (Group II) and tadalafil 5 mg once daily (Group III). The aim was to compare spontaneous expulsion of stone between those drugs Results: The mean expulsion time from the start of MET was 11.5 ± 3.27 days for ketoprofen group, 10.71 ± 3.98 days for silodosin group and 10.57 ± 3.40 days for tadalafil group. But these differences were also not significant (P = 0.79). The use of analgesics (grade II) was higher in groups II and III compared to group I, but without significant difference (23.33% in group I, 33.33% in group II and 40% in group III, p = 0.38). Discussion: The overall chance of spontaneous passage is low when the stone diameter is sized more than 7 mm. A wide range of spontaneous passage rates have been reported in the literature, varying from 71% to 98% for distal ureteral stones less than 5 mm and 25% - 53% for stone sized 5 to 10 mm with a mean expulsion time of more than 10 days. Conclusion: The three drugs have a low expulsion rate for 8, 9 and 10 mm pelvic ureteral stones with a higher adverse event rate for the NSAID group.