“Yes, because anecdotally medical expulsive therapy works. Actually, some studies show it works a little bit. It’s one of those things—it can’t hurt. I’ve seen people pass stones that no human being should be able to pass. I can’t attribute it 100% to MET, it could just be their anatomy, but I’ve seen it.
If the patient has gone to the emergency room on Tuesday and shows up at your office on Thursday, you don’t know where the stone is for sure, whether it’s mid or proximal. So if I don’t have an immediate film, I give them the medication on the benefit of the doubt that the stone is hopefully distal. You may be told that it’s proximal, but 3 days later, maybe it is a distal stone.
More Speak Out: How do you approach giving bad news to patients?
The only real [alpha-blocker] side effect to worry about is orthostasis. If they’re dehydrated, they may get a little orthostatic, but generally part of the treatment to try to pass a stone is hydration, so that almost eliminates that as a problem by just making sure they’re hydrated. The other side effect is that it tends to lower blood pressure or cause retrograde ejaculation. But temporarily, who cares?”
Todd Cohen, MD