Ureteral Stones

reteric colic represent one of the common medical problem encountered by urologists in the emergency room, they are usually caused by ureteral stones. Management of such condition is usually conservative at first, if the stone fail to pass a more prompt action is needed, which is usually by one of the minimally invasive procedures like extracorporeal shockwave lithotripsy (ESWL), ureteroscopy, or percutaneous nephrolithotomy, depending on the stone size, location and the presence and degree of associated obstruction. (1) However, these minimally invasive procedures are not risk free and expensive for patients, for these reasons a new approach that lies in between the observational conservative therapy and the interventional therapy, what's called now "medical expulsion therapy of ureteral stones", which is the use of drugs to induce ureteric relaxation and enhance stone passage.
Two factors mainly influencing calculi expulsion are: 1. Pathological factors including infection, edema, and contraction of urinary tract; 2. Calculi factors including size, shape, and location of calculi. Among these, location and size of calculi are the most important factors. (2) A recent meta-analysis shows an overall spontaneous stone passage rate of 68% for ureteric stone 5 mm and 10 mm. (3)Timeto pass also depends on the stone size, stones up to 2mm taking 8 days to pass, stones 4‐6 mm taking 22 days to pass, (4) however, most authors recommend that stone passage time should not exceed 4‐6 weeks to avoid the risk of renal damage. (1),