Fact facts on -blocker as

MET
Stone expulsion rate was 70-88,9%
(Zhang et al,2009; Sayed et al, 2008)

Pts with MET had a 23% change of surgery vs

32% in pts without MET (p<0,05)
(Kaplon et el, 2009)

Second cycle Tamsulosin (10 days) safe and

effective
Increase explusion rat (80%)
(Porpiglia et al, 2009)

MET decreases the incidence of surgical adverse

events by 29% and the total cost by 24%
(Brede C et al,2010)

Meta-analysis of 16 studies of blocker

Tamsulosin was used in 13 of 16 studies.
Terazosin and Doxazosin in others
1235 patients with distal ureteral stones
Stone size 4.3 to 7.8 mm.
Alpha antagonist therapy improved stone
passage (RR 1.59, CI 1.44-1.75, NNT 3.3)
Mean time explusion <14 days
Stone explusion was 2-6 days earlier than control
Adverse effects in 4% Mild.
(Singh et el, 2007)

A meta-analysis of 47 MET
studies
Stone size and MET
Higher efficacy of stone explusion rates for
<5mm than 5-10 mm

Tamsulosin more favourable than nifedipine

Adjuvant use of MET after ESWL , increased
explusion rate
Corticosteroid
combination
might
be
beneficial
(Bensalah et al, 2008)

Cost benefit analysis

German
y

Turkey

UK

Italy

USA

$160

$491

$926

$1585

$4773

Medical explusive therapy

$77

$179

$312

$545

$1493

Observation
Point of cost effectiveness
for MET benefit*

$88
40%

$270
10%

$509
7%

$927
4%

$2625
1%

URS and stone

fragmentation cost (9,23)
Model outcomes $

UK, United Kingdom, USA, United States; URS, ureteroscopy; MET, medical
explusive therapy
Ureteroscopy in Germany costs $160 as an outpatient but $800 per day as
an inpatient procedure
Assuming spontaneous stone passage rate of 45% (3) and medication cost of
$28 ($2 per pill)
*Incremental Increase in spontaneous stone passage rates with MET.

(Bensalah et al, 2008)

Stone size MET Success

rate
< 8mm = ESWL procedure

(Zhang et al,

2009)

<10 mm

(Seitz et al, 2009; Singh et al 2007, Liu et al,

2007)

9 mm

(EAU guideline 2009)

Comparison with other

drugs
Ca Channel blocker reduce spontaneus
rhtymic ureteral contraction
Only 9% more pts have spontaneus explusion,
compared to 29% in -blocker treatment
(EAU guideline, 2009)

No recommendation about superiority between

alpha blockers or nifedipine
(Seitz et al 2009: Singh et al, 2007)

Combination with corticostreoid

Slight improvement
al, 2006)

(EAU guideline, 2009; Porpiglia et

Conclusions
Medical Explusive Therapy:
Distal ureteral stone
Stone size < 9 mm
Course: 4 weeks
Non-invasive / minimal invasive
treatment may intervene MET

MET post ESWL

MET+ESWL improve success rate at 17%
(compared to ESWL alone) even for stone
> 10 mm
(Schuler TD et al, 2009; Miculi S et al,2007)

Tamsulosin improves clearance rate of

Upper Ureteral Stone after single ESWL
(Agarwal et al, 2009)

Tamsulosin after ESWL increase stone

clearance in pts with renal and ureteric
calculi
(Zhu Y et al, 2009)