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Invited Commentary
June 18, 2018

Medical Expulsive Therapy for Ureteral Stones—Stone Age Medicine

Author Affiliations
  • 1Department of Urology, University of Minnesota, Minneapolis
  • 2Department of Urology, University of Michigan, Ann Arbor
JAMA Intern Med. Published online June 18, 2018. doi:10.1001/jamainternmed.2018.2265

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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