The rising incidence of urinary stone disease in children requires pediatric practitioners to keep abreast of management recommendations which are generally geared towards adults. Medical expulsive therapy (MET) is a non-surgical therapeutic option that can be trialed in patients who present with uncomplicated symptomatic ureteral stones. Seminal articles published and indexed in Medline on the topic of MET were extracted and reviewed. Studies suggest a potential benefit of alpha-blockade for the expulsion of distal ureteral stones that are >5 mm but ≤10 mm in adults and possibly >4 mm in children. Conversely, there does not seem to be any added benefit for MET in smaller stones (<5 mm) in which the spontaneous passage rate is high. Conclusions: The off-label use of these medications is one of the several barriers which contribute to the underutilization of MET in children. However, these may be a reasonable option in particular for older children and adolescents with the appropriate-sized stones.
Indian pediatrics. 2020 Aug 07 [Epub ahead of print]
Selasie Q Goka, Lawrence Copelovitch
Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States., Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States. Correspondence to: Dr Lawrence Copelovitch, The Children's Hospital of Philadelphia, Division of Nephrology, 3501 Civic Center Boulevard, Philadelphia, PA 19104. .