Beyond medical expulsive therapy: evolution to supported stone passage for ureteric stones

Andrew J. Portis, Jennifer L. Portis, Michael S. Borofsky, Suzanne M. Neises

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


OBJECTIVE: To evaluate the impact of removing tamsulosin from standardized ureteric stone clinical protocols on rate of stone surgery.

PARTICIPANTS AND METHODS: We conducted a single-centre, comparison of all patients with unilateral, <1 cm ureteric stones presenting to a stone clinic after discharge from the emergency department during consecutive years. In the initial year, patients were initially offered medical expulsive therapy (MET) with tamsulosin. In the subsequent year, the protocol was modified to focus on symptom control without tamsulosin; this was termed 'supported stone passage' (SSP). The primary outcome was rate of stone surgery within 90 days of the initial clinic encounter.

RESULTS: Among 723 patients (360 MET, 363 SSP), the rate of attempted stone passage increased from 65% to 74%, between the initial and the subsequent year (P < 0.016). Tamsulosin prescription in patients to attempting stone passage decreased from 84% to 13% (P < 0.001). In patients attempting stone passage, the rate of stone surgery was 26% in the METand 19% in the SSP group (P = 0.066). The overall surgery rate decreased from 51% in the MET group to 40% in the SSP group (P = 0.003). Multivariable analysis, controlling for age, sex and stone burden, did not demonstrate a difference in either rate of attempting to pass stones or in rate of failure of passage according to care protocol. We were unable to demonstrate an independent effect of tamsulosin on failure of passage. Overall, surgical intervention was less likely in the SSP phase than in the MET phase, with an odds ratio of 0.64 (confidence interval) 0.44-0.91; P = 0.013).

CONCLUSIONS: Removing tamsulosin from clinical protocols did not impair stone passage in patients attempting to pass stones.

Original languageEnglish (US)
Pages (from-to)661-668
Number of pages8
JournalBJU International
Issue number4
StatePublished - Apr 2019

Bibliographical note

Publisher Copyright:
© 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd


  • medical expulsive therapy
  • tamsulosin
  • ureteric stones
  • ureteroscopy
  • Double-Blind Method
  • Humans
  • Middle Aged
  • Clinical Protocols
  • Male
  • Treatment Outcome
  • Ureteral Calculi/physiopathology
  • Adrenergic alpha-1 Receptor Antagonists/administration & dosage
  • Quality Improvement
  • Adult
  • Aged
  • Tamsulosin/administration & dosage

PubMed: MeSH publication types

  • Journal Article
  • Comparative Study


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