WCE 2017: Medically Expulsive Therapy: Fact or Fiction

Vancouver, Canada (UroToday.com)  Dr. Hollingsworth, an associate professor from the University of Michigan began the debate for medically expulsive therapy (MET) for ureteral stones by bringing up a paper written by Pikard et al. (the SUSPEND trial) and debunking it. Looking at the data more closely, he was surprised to find that spontaneous stone passage in the control group was 80%, which seemed really high. He further looked into the population characteristics of the study and stated that the majority of the patients had smaller stones < 5mm stones and they were primarily distal. He finished by stating that meta-analysis data shows a benefit of MET for larger ureteral stones.

Dr. Bultitude, a urologist from Guys and St Thomas' Hospitals argued for the elimination of MET for ureteral stones. He cautioned that meta-analyses are wrong 35% of the time. He said it is essential to look at the quality of data used. For instance, an older study publish in the Lancet indicated a 65% risk benefit of MET, however the 9 studies included were poorly conducted; not blinded, not randomized, and full of publication bias. Dr. Bultitude presented the most recent meta-analysis which showed no benefit with MET. He reminded us that drugs we use for MET have their side effects and that we should not be give them out like “M&Ms.”

Dr. Hollingsworth, the proponent of MET therapy, stated that if we looked at only the most high powered randomized control trials, MET therapy shows a benefit for patients with larger and distal stones. Dr. Bultitude countered by stating that the biggest studies  only show trends towards a benefit, and only a few show a small difference. He concluded by citing that MET therapy is dead and that it indeed has “followed the path of the dinosaur.”

The debate was well received, and when the audience was polled for who continues to use MET therapy, the responses were split at 50-50.

Presented by: Matthew Bultitude, John Hollingsworth, MD, MS

Plenary Chairs: John Denstedt, MD, FRCSC, FACS, FCAHS, Margaret Pearle, MD, PhD, 
Session Chair: Stephen Y. Nakada, MD, FACS,

Affiliation: Guys and St Thomas' Hospitals, University of Michigan,  Division of Urology, Western University, London, Ontario, Canada, Department of Urology, UT Southwestern, University of Wisconsin School of Medicine and Public Health

Written by: Egor Parkhomenko, Department of Urology, University of California-Irvine at 35th World Congress of Endourology– September 12-16, 2017, Vancouver, Canada.