In this issue of JAMA Internal Medicine, Meltzer and colleagues1 report the results of a randomized clinical trial assessing the role of an α-blocker, tamsulosin, among patients presenting to the emergency department with renal colic secondary to a ureteral stone. In the absence of indications for immediate intervention (eg, pyelonephritis, obstruction of a solitary kidney, intractable pain), a trial of conservative treatment is warranted in this population, given that many patients will pass their stones spontaneously. However, since a number will fail conservative treatment and require a procedure for stone removal, there is great interest in strategies for increasing the likelihood of stone passage. The use of α-blockers like tamsulosin and calcium channel blockers, commonly referred to as medical expulsive therapy, has been championed as one such strategy.
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Dahm P, Hollingsworth JM. Medical Expulsive Therapy for Ureteral Stones—Stone Age Medicine. JAMA Intern Med. 2018;178(8):1058–1059. doi:10.1001/jamainternmed.2018.2265
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