Medical expulsive therapy or bust?
The bottom line
Dr. Nakada said that while he doesn’t think The Lancet study was the last word on MET use in kidney stone patients, the findings were powerful.
“There’s going to be a substantial North American [National Institutes of Health] study, the results of which will come out this spring. That is a direct comparison of tamsulosin to placebo. That could be the last word,” Dr. Nakada said. “That being said, I tend to lean toward The Lancet findings, because, even in my own clinical practice, I’ve not noticed a tremendous change in how patients pass stones despite using tamsulosin routinely for nearly a decade.”
Dr. Preminger said he and colleagues who wrote the AUA guidelines on the topic stand by MET’s worth.
“One of the arguments in The Lancet article was that they would not treat with MET to save their medical resources for something else,” Dr. Preminger said. “My argument would be that if treatment with tamsulosin is safe, relatively effective, and inexpensive, and it can prevent the need for ureteroscopy or shock wave lithotripsy, why not use it? We see very little downside and significant upside to medical expulsive therapy.”
According to Dr. Preminger, the AUA guidelines panel recently launched a new set of guidelines for surgical stone management, which was presented at the 2016 AUA annual meeting in San Diego.
“The guidelines support the use of MET, and I should note that this large meta-analysis that was just reported in The BMJ commented that their meta-analysis supported the guidelines. So, the two are in agreement,” Dr. Preminger said.
There is a better alternative to MET, Dr. Nakada said. That is kidney stone prevention.
“Prevention, in terms of improved diet, improved hydration status, and medical intervention represent the best possible scenario,” Dr. Nakada said. “To prevent stones in the first place is the holy grail.”
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