Abstract

Introduction: Urinary calculi are a common complaint, affecting the cases in a ratio of 3 men to 1 woman, with advanced incidence between 40 to 50 years of age. Size of the calculus influences the rate of spontaneous calculus passage. Medical expulsive therapy (MET) has been described as an effective conservative treatment option in the initial management of small distal ureteral/ Vesico-Ureteric Junction (VUJ). Ureteroscopy (URS) is indicated in unsuccessful cases of MET. Current European Association of Urology advocates the use of URS as first line treatment for distal ureteric calculus larger than 10 mm.

Methods: The study was conducted at a tertiary care hospital in Gujarat, India, nvolving both outpatient and inpatient cases. Patients underwent radiological, blood, and urine evaluations. They were instructed to take silodosin, deflazacort, diclofenac, and maintain supra-hydration. Follow-ups were scheduled every 7 days with X-ray KUB to monitor spontaneous calculus passage. If stone passage was unsuccessful after 28 days, patients underwent planned URS with or without lithotripsy and DJ stenting under anaesthesia.

Results: In a cohort of 170 patients with small distal ureteral stones, 89% were successfully managed with medical expulsive therapy (MET), while 11% required ureteroscopy (URS) after unsuccessful MET. Comparative analyses considered factors such as patient demographics, stone characteristics, medical history, lab results, and URS findings, leading to the study’s conclusions.

Conclusion: Our study has 170 patients with mid and distal ureteric calculi with size ranging from 4 to 10 mm with mild or no backpressure changes, which were subjected to MET with tablet silodosin, tablet deflazacort, tablet diclofenac and supra-hydration. We documented 88.8% MET success and 11.2% unsuccessful cases of MET. MET success is unaffected by age, gender of the patient, history of prior surgical procedure, diabetic status, hypertension or recurrent stone former status. For calculus size between 4 to 10 mm stone-free rate was achieved with medical therapy in 88.8% of patients with no overt complications. Size of the calculus is a significant predictor of expulsion rate. In our study all cases with unsuccessful MET underwent ureteroscopy for calculus clearance.

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