Medical expulsive therapy

Do all stones need surgery?

No. Many small ureteral stones can pass spontaneously.

The likelihood depends mainly on:

• size;
• location;
• anatomy;
• clinical course.

Small, distal stones have a higher probability of spontaneous passage than large, proximal ones.

As a guide, the EAU reports spontaneous passage in approximately three quarters of stones smaller than 5 mm; small distal stones have the highest chances of passing.

We can observe if:

• pain is controlled;
• there is no infection;
• renal function is preserved;
• there is no indication for intervention;
• the patient understands the warning signs;
• follow-up is possible.

Medical expulsive therapy

In selected patients, an alpha-blocker can be used to facilitate ureteral stone passage.

Current evidence shows that the greatest benefit is seen especially in distal ureteral stones of 5–10 mm.

Alpha-blockers used for this purpose are an off-label treatment.

Expulsive therapy should not be prescribed when there is an indication for active stone removal.

And the conservative strategy should be stopped if the following appear:

• infection;
• refractory pain;
• impaired renal function;
• another complication.