Canós Nebot Ángela, de la Encarnación Castellano Cristina, Caballero Romeu Juan Pablo, Galán Llopis Juan Antonio
Servicio de Urología. Hospital General Universitario de Alicante. Alicante. España.
Servicio de Urología. Hospital General Universitario de Alicante. Alicante. España. Alicante Institute for Health and Biomedical Research (ISABIAL). Alicante. España.
Arch Esp Urol. 2021 Jan;74(1):80-93.
Medical Expulsive Treatment (MET) for ureteral stones has been questioned for the last few years.
The main goal of our study is to define the indications of MET, the different drugs that are used and their effectiveness and to propose a follow-up strategy. Secondary objectives include the effectiveness of MET in some special subgroups such as pregnant women and children and to assess aspects of MET cost-effectiveness compared with other options for ureteral lithiasis treatment (ureterorenoscopy or extracorporeal shock wave lithotripsy).
We have reviewed the most relevant clinical trials and meta-analysis evaluating the impact of the different drugs available for MET. For the research we used some keywords like "medical expulsive treatment/therapy", "ureteral lithiasis", "urolithiasis", "effectiveness", "alpha-blockers" and "calcium-antagonists". MEDLINE database was used for there search (using the portal web Pubmed).
Highest quality studies currently availables how significant methodological limitations leading to heterogeneous and restricted evidence, which is only applicable to patients and lithiasis with specific conditions. Nevertheless, in general terms, it seems that MET can play a certain role in the expulsion of lithiasis ≥ 5mm y ≤ 10 mm located in the distal ureter, although it has not been possible to demonstrate that any of the drugs used may have special superiority in terms of effectiveness. In pregnancy and children, the recommendations of MET are also irregular. Finally, MET seemsto be an alternative cost-effective compared to active options of treatment.
Higher quality clinical trials are needed to reliably advice MET. With the current evidence, it appears that MET can improve the expulsion of distal ureteral lithiasis ≥ 5 mm and ≤ 10 mm, even though we have not found differences between the drugs that are available for MET.
过去几年，输尿管结石的药物排石治疗（MET）一直备受质疑。
我们研究的主要目标是明确MET的适应证、所使用的不同药物及其有效性，并提出一种随访策略。次要目标包括MET在孕妇和儿童等一些特殊亚组中的有效性，以及与输尿管结石治疗的其他选择（输尿管镜检查或体外冲击波碎石术）相比评估MET的成本效益方面。
我们回顾了评估可用于MET的不同药物影响的最相关临床试验和荟萃分析。为进行这项研究，我们使用了一些关键词，如“药物排石治疗/疗法”“输尿管结石”“尿路结石”“有效性”“α受体阻滞剂”和“钙拮抗剂”。使用MEDLINE数据库进行检索（通过网络门户PubMed）。
目前质量最高的研究显示存在显著的方法学局限性，导致证据异质性且有限，仅适用于特定条件的患者和结石。然而，总体而言，MET似乎在排出位于输尿管远端、直径≥5mm且≤10mm的结石方面可发挥一定作用，尽管尚未能够证明所使用的任何药物在有效性方面具有特殊优势。在孕妇和儿童中，MET的推荐也不规范。最后，与积极的治疗选择相比，MET似乎是一种具有成本效益的替代方案。
需要更高质量的临床试验来可靠地指导MET。根据目前的证据，尽管我们尚未发现可用于MET的药物之间存在差异，但MET似乎可以提高直径≥5mm且≤10mm的远端输尿管结石的排出率。
