Medically expulsive therapy (MET) has no benefit in improving spontaneous stone passage (SSP)

Published Date: 14th May 2018

Publication Authors: Mbuvi J

Introduction & Objectives

There is conflicting evidence on the role of medical expulsive therapy (MET) in spontaneous stone passage in patients with acute ureteric colic. Randomised trial data has not shown a role for MET use, though these have been underpowered to explore its role in specific patient subgroups. It is unknown whether MET use may have a role in aiding stone passage for stones of a particular size or specific position in the ureter. We undertook MIMIC, a multi-centre international cohort study in 71 centres disseminated via the UK British Urology Researchers in Surgical Training (BURST) to assess whether MET use improved rates of SSP adjusting for key confounders such as stone size and stone position. 

Materials & Methods

Multivariable mixed effects logistic regression models were created fitted for MET use, Age, Gender, Stone size and Stone position. To explore the effect of stone size (mm) and stone position (upper ureter, middle ureter and lower ureter) on whether MET use had an effect on SSP, an interaction term was fitted between these variables. 

Results

Data were collected from 4181 patients admitted with acute ureteric colic. 75% (n=3127) were discharged with conservative management. 80% (n=2516) had a confirmed outcome of SSP and were included in the multivariable analysis. The unadjusted odds ratio for the association of MET use with SSP from univariable analysis was 1.250 (95%CI, 1.041, 1.501). However, following a multivariable mixed effects logistic regression model adjusting for age, gender, stone size, position, treating stone size and stone

position as interaction terms, there was no association of MET use with SSP in any subgroup irrespective of stone size (OR 1.085, 95%CI 0.978, 1.205) or stone position: middle ureter (OR 0.808, 95%CI 0.458, 1.424), upper ureter (OR 1.086, 95%CI 0.716, 1.645)). The overall OR for MET use was 0.861 (95%CI 0.521, 1.424). 

Conclusions

Our data shows that in patients with acute ureteric colic who are suitable for initial conservative management, MET use has no benefit in spontaneous stone passage, regardless of stone size or stone position and should not be routinely prescribed.

Shah, TT; Mbuvi, J et al. (2018). Medically expulsive therapy (MET) has no benefit in improving spontaneous stone passage (SSP) in patients presenting with acute ureteric colic: Results from the MIMIC study . European Urology Supplements. 17 (2), e919-922

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