Objective: The study aimed to evaluate the predictive value of ureteral wall thickness (UWT) and stone-related parameters for medical expulsive therapy (MET) success with an alpha blocker in pediatric upper ureteral stones. Patients and Methods: A total of 35 children receiving MET ureteral stones (<10 mm) were evaluated. Patients were divided into 2 subgroups where MET was successful in 18 children (51.4%) and unsuccessful in 17 children (48.6%). Prior to management, stone size, stone density (in Hounsfield unit), degree of hydronephrosis, and UWT were evaluated with patient demographics and recorded. The possible predictive value of these parameters in success rates and time to stone expulsion were evaluated in a comparative manner between the 2 groups. Results: The overall mean patient age and stone size values were 5.40 ± 0.51 years and 6.24 ± 0.28 mm, respectively. Regarding the predictive values of these parameters for the success of MET, while stone size and UWT were found to be highly predictive for MET success, patients age, body mass index, stone density, and degree of hydronephrosis had no predictive value on this aspect. Conclusions: Our findings indicated that some stone and anatomical factors may be used to predict the success of MET in pediatric ureteral stones in an effective manner. With this approach, unnecessary use of these drugs that may cause a delay in removing the stone will be avoided, and the possible adverse effects of obstruction as well as stone-related clinical symptoms could be minimized.

Keywords:
Predictive, Ureteral stone, Medical expulsive therapy, Stone expulsion
1.
Kroovand RL: Pediatric urolithiasis. Urol Clin North Am 1997;24:173-184.
2.
Minevich E: Pediatric urolithiasis. Pediatr Clin North Am 2001;48:1571-1585.
3.
Erbagci A, Erbagcı AB, Yilmaz M, et al: Pediatric urolithiasis - evaluation of risk factors in 95 children. Scand J Urol Nephrol 2003;37:129-133.
4.
Koyuncu H, Yencilek F, Erturhan S, et al: Clinical course of pediatric urolithiasis: follow-up data in a long-term basis. Int Urol Nephrol 2011;43:7-13.
5.
Sarica K: Medical aspect and minimal invasive treatment of urinary stones in children. Arch Ital Urol Androl 2008;80:43-49.
6.
Lopez M, Hoppe B: History, epidemiology and regional diversities of urolithiasis. Pediatr Nephrol 2010;25:49-59.
7.
Hollingsworth JM, Norton EC, Kaufman SR, et al: Medical expulsive therapy versus early endoscopic stone removal for acute renal colic: an instrumental variable analysis. J Urol 2013;190:882-887.
8.
Coll DM, Varanelli MJ, Smith RC: Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. AJR Am J Roentgenol 2002;178:101-103.
9.
Seitz C, Liatsikos E, Porpiglia F, et al: Medical therapy to facilitate the passage of stones: what is the evidence? Eur Urol 2009;56:455-471.
10.
Pedro RN, Hinck B, Hendlin K, et al: Alfuzosin stone expulsion therapy for distal ureteral calculi: a double-blind, placebo controlled study. J Urol 2008;179:2244-2247; discussion 2247.
11.
Lee SR, Jeon HG, Park DS, et al: Longitudinal stone diameter on coronal reconstruction of computed tomography as a predictor of ureteral stone expulsion in medical expulsive therapy. Urology 2012;80:784-789.
12.
Hollingsworth JM, Wolf JS Jr, Faerber GJ, et al: Understanding the barriers to the dissemination of medical expulsive therapy. J Urol 2010;184:2368-2372.
13.
Singh A, Alter HJ, Littlepage A: A systematic review of medical therapy to facilitate passage of ureteral calculi. Ann Emerg Med 2007;50:552-563.
14.
Malin JM Jr, Deane RF, Boyarsky S: Characterisation of adrenergic receptors in human ureter. Br J Urol 1970;42:171-174.
15.
Preminger GM, Tiselius HG, Assimos DG, et al: Guideline for the management of ureteral calculi. J Urol 2007;178:2418-2434.
16.
Porpiglia F, Vaccino D, Billia M, et al: Corticosteroids and tamsulosin in the medical expulsive therapy for symptomatic distal ureter stones: single drug or association? Eur Urol 2006;50:339-344.
17.
Hermanns T, Sauermann P, Rufibach K, et al: Is there a role for tamsulosin in the treatment of distal ureteral stones of 7 mm or less? Results of a randomised, double-blind, placebo-controlled trial. Eur Urol 2009;56:407-412.
18.
Van Savage JG, Palanca LG, Andersen RD, et al: Treatment of distal ureteral stones in children: similarities to the American urological association guidelines in adults. J Urol 2000;164(3 pt 2):1089-1093.
19.
Abhishek, Kumar J, Mandhani A, et al: Pediatric urolithiasis: experience from a tertiary referral center. J Ped Urol 2013;9(6 pt A):825-830.
20.
Lotan Y, Gettman MT, Roehrborn CG, et al: Management of ureteral calculi: a cost comparison and decision making analysis. J Urol 2002;167:1621-1629.
21.
Velázquez N, Zapata D, Wang HH, et al: Medical expulsive therapy for pediatric urolithiasis: systematic review and meta-analysis. J Pediatr Urol 2015;11:321-327.
22.
Hochwind C, Ashcroft K: Tamsulosin for ureteral stones - use in a pediatric population? Urol Nurs 2012;32:88-92.
23.
Atan A, Balcı M: Medical expulsive treatment in pediatric urolithiasis. Turk J Urol 2015;41:39-42.
24.
Lee SR, Jeon HG, Park DS, et al: Longitudinal stone diameter on coronal reconstruction of computed tomography as a predictor of ureteral stone expulsion in medical expulsive therapy. Urology 2012;80:784-789.
25.
Faerber GJ: Pediatric urolithiasis. Urology 2001;11:385-389.
26.
Spivacow FR, Negri AL, del Valle EE, et al: Metabolic risk factors in children with kidney stone disease. Pediatr Nephrol 2008;23:1129-1133.
27.
Gurocak S, Kupeli B, Acar C, et al: The impact of pelvicaliceal features on problematic lower pole stone clearance in different age groups. Int Urol Nephrol 2008;40:31-37.
28.
Sarica K: Pediatric urolithiasis: etiology, specific pathogenesis and medical treatment. Urol Res 2006;34:96-101.
29.
Hoppe B, Jahnen A, Bach D, et al: Urinary calcium oxalate saturation in healthy infants and children. J Urol 1997;158:557-559.
30.
Nicoletta JA, Lande MB: Medical evaluation and treatment of urolithiasis. Pediatr Clin North Am 2006;53:479-491.
31.
Segura JW, Preminger GM, Assimos DG, et al: Ureteral stones clinical guidelines panel summary report on the management of ureteral calculi. The American Urological Association. J Urol 1997;158:1915-1921.
32.
Hollingsworth JM, Rogers MA, Kaufman SR, et al: Medical therapy to facilitate urinary stone passage: a meta-analysis. Lancet 2006;368:1171-1179.
33.
Pietrow P, Pope JC, Adams MC, et al: Clinical outcome of pediatric stone disease. J Urol 2002;167(2 pt 1):670-673.
34.
Wang CJ, Huang SW, Chang CH: Efficacy of an alpha1 blocker in expulsive therapy of lower ureteral stones. J Endourol 2008;22:41-46.
35.
Aldaqadossi HA, Shaker H, Saifelnasr M, et al: Efficacy and safety of tamsulosin as a medical expulsive therapy for stones in children. Arab J Urol 2015;13:107-111.
36.
Aydogdu O, Burgu B, Gucuk A, et al: Effectiveness of doxazosin in treatment of distal ureteral stones in children. J Urol 2009;182:2880-2884.
37.
Mokhless I, Zahran AR, Youssif M, et al: Tamsulosin for the management of distal ureteral stones in children: a prospective randomized study. J Pediatr Urol 2012;8:544-548.
38.
Erturhan S, Bayrak O, Sarica K, et al: Efficacy of medical expulsive treatment with doxazosin in pediatric patients. Urology 2013;81:640-643.
39.
Tasian GE, Cost NG, Granberg CF, et al: Tamsulosin and spontaneous passage of ureteral stones in children: a multi-institutional cohort study. J Urol 2014;192:506-511.
40.
Lojanapiwat B, Kochakarn W, Suparatchatpan N, Lertwuttichaikul K: Effectiveness of low-dose and standard-dose tamsulosin in the treatment of distal ureteric stones: a randomized controlled study. J Int Med Res 2008;36:529-536.
41.
Pickard R, Starr K, MacLennan G, et al: Use of drug therapy in the management of symptomatic ureteric stones in hospitalised adults: a multicentre, placebo-controlled, randomised controlled trial and cost-effectiveness analysis of a calcium channel blocker (nifedipine) and an alpha-blocker (tamsulosin) (the SUSPEND trial). Health Technol Assess 2015,19:vii-viii, 1-171.
42.
Sahin C, Eryildirim B, Kafkasli A, et al: Predictive parameters for medical expulsive therapy in ureteral stones: a critical evaluation. Urolithiasis 2015;43:271-275.
43.
Sarica K, Kafkasli A, Yazici O, et al: Ureteral wall thickness at the impacted ureteral stone site: a critical predictor for success rates after SWL. Urolithiasis 2015;43:83-88.
© 2017 S. Karger AG, Basel
2017
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.