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Medical expulsive therapy (MET) for kidney (renal) stones

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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  • Medical Expulsive Therapy (MET) - use of medical therapies to facilitate the passage of the stone

    (1,2,3,4) - stones <4 mm have a 95% chance of spontaneous passage within 40 days (5)
    • useful in cases where there is no obvious reason for immediate surgical removal
    • medical options include calcium-channel blockers (eg, nifedipine) or alpha-blockers (eg, tamsulosin)
    • small, less than 5-mm distal ureteral stones, will most likely spontaneously pass within 4 weeks, without the need for urologic intervention (1)
    • for 5-10mm stones, MET may increase the passage rate by 30%. With smaller stones, it may reduce transit time and symptoms (2) possible side effects include postural hypotension and retrograde ejaculation
      • best evidence is for alpha-blockers (tamsulosin 400 microgram once a day)
      • medical expulsive therapy with α-blockers, such as tamsulosin 400 mcg once daily (off label indication), for 1 month may accelerate spontaneous passage of distal stones, particularly those >5 mm (5) -
  • a corticosteroid such as prednisolone is occasionally added when an alpha-blocker is used (but should not be given as monotherapy) (3)
    • though a review stated that "..wiith regard to MET, we support use of tamsulosin for medical expulsive therapy in appropriate patients due to the favorable side effect profile and the evidence for decreased time to stone passage. At this time we do not feel there is sufficient evidence to recommend addition of corticosteroid therapy..." (4)

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