CUA 2018: Medical Expulsive Therapy in Pregnancy: A Retrospective Study

Halifax, Nova Scotia ( The management of urolithiasis during pregnancy is a challenge. The use of medical expulsive therapy (MET) is increasingly common in the symptomatic management of urolithiasis. The use of MET during pregnancy is very controversial due to lack of safety and efficacy data. When pregnant women are presented with renal colic, selection of management strategy is dependent on the trimester. Common and first line recommendation is active observation. With proper management of pain symptoms, observation is a viable option to let the stone pass without any further intervention. In these cases, MET can hypothetically facilitate and improve the stone passage. 

Authors performed a retrospective study to evaluate the safety and efficacy of an alpha-blocker (Tamsulosin 0,4mg once a day) as a MET in pregnant women. Authors retrospectively identified pregnant patients who presented with renal colic at their hospital from 2000 to 2015. Patients who received Tamsulosin were compared to those who did not receive any MET. Efficacy of stone passage rate and intervention rate was assessed and compared. 

Theriault Benoit, MD, reported that there was no difference in maternal age of the patients, prior incidents of urolithiasis. All perinatal outcomes also showed no difference between the groups (table 1). 

Table 1. 
UroToday CUA 2018 Medical Expulsive Therapy in Pregnancy

Authors concluded that spontaneous passage was superior in the MET group, however, did not reach the statistical difference. Longer passage time was demonstrated in MET group. There limitations to the study including its retrospective design and lack of stone size. These factors may have significantly impacted the study outcomes. Further, prospective randomized studies are needed to elucidate the role of MET in pregnant patients with urolithiasis.

Presented by: Theriault Benoit, MD, Division of Surgery, Urology Program, University Hospital of Quebec - Laval University
C-Authors: Morin Fannie, Julien Anne-Sophie, Perronn Sophie, Cloutier Jonathan
Author Information: Division of Surgery, Urology Program, University Hospital of Quebec - Laval University

Written By: Zhamshid Okhunov (Twitter: @OkhunovZham), (Department of Urology, University of California-Irvine) medical writer for at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia