A related editorial discusses this research. It highlights that medical expulsive therapy was popularized by a systematic review and meta-analysis published in 2006. Nine trials on medical expulsive therapy existed in the literature at that time. When data from these trials were pooled, the authors found that use of α-blockers inpatients with ureteral stones was associated with a 54% higher risk of stone passage compared with no treatment. Evidence has however moved on since this paper, and the findings of this study are consistent with those of a previous high-profile, multicenter randomized clinical trial from the United Kingdom that involved more than 1100 patients with ureteral stones (the Spontaneous Urinary Stone Passage Enabled by Drugs, or SUSPEND trial), which showed medical expulsive therapy to be no more efficacious than placebo at decreasing 4-week rates of intervention for stone clearance.
Commentators agree with the study authors that guideline recommendations on medical expulsive therapy should be revisited. However, to say tamsulosin has no benefit for ureteral stones up to 9mmin size may be an overreach, given that nearly three-quarters of patients in their study had ureteral calculi 4mm or smaller in size.