Non-Surgical Treatment to Help You Pass a Stone Naturally
At Fore River Urology, not all kidney stones require surgery. For patients with smaller stones and manageable symptoms, one of the options is a treatment approach called medical expulsive therapy (MET). This involves using medications and hydration to help you pass a kidney stone naturally, often avoiding procedures altogether.
What Is Medical Expulsive Therapy?
Medical expulsive therapy is a non-invasive treatment that uses medications to help relax the ureter—the tube that connects the kidney to the bladder—and allow a stone to pass more easily.
This approach is typically recommended for:
- Small ureteral stones (usually less than ~6 mm)
- Stones located in the lower ureter
- Patients without infection or severe symptoms
- Those who want to avoid or delay surgery
How Does It Work?
We use alpha-blockers (such as tamsulosin, also known as Flomax) to relax the smooth muscle of the ureter, improving the chances of the stone passing on its own.
The treatment plan may include:
- A prescription for an alpha-blocker
- Pain medications (NSAIDs or acetaminophen as needed)
- Instructions to drink plenty of fluids
- Straining urine to catch the stone for analysis
- Follow-up imaging to confirm passage (unless stone is caught by strainer)
How Long Does It Take to Pass a Stone?
Most stones that are going to pass on their own will do so within 4 weeks.
When Is MET Not Recommended?
Medical expulsive therapy is not appropriate for:
- Larger stones (>6 mm) that are unlikely to pass
- Stones causing fever, infection, or sepsis
- Patients with severe pain or worsening kidney function
- Pregnant patients (certain medications are not safe)
In these cases, we may recommend procedures like a ureteral stent placement, ureteroscopy with laser lithotripsy or shockwave lithotripsy (ESWL).
What Are the Risks of MET?
While medical expulsive therapy is safe and effective for many patients, it’s not without potential risks. These include:
1. Ongoing Pain and Discomfort
Passing a kidney stone can be painful—even with medication. Some patients experience intermittent or constant discomfort for days or weeks during the process. Pain may increase as the stone moves closer to the bladder.
2. Prolonged Use of Pain Medications
To manage discomfort, you may be prescribed or advised to use NSAIDs (like ibuprofen) or other pain relievers. Prolonged or high-dose use can lead to:
- Stomach irritation or ulcers
- Elevated blood pressure
- Kidney function issues, especially in those with preexisting conditions
We’ll work with you to ensure medications are used safely and appropriately.
3. Risk of Obstruction or Infection
If the stone becomes stuck or causes a blockage in the ureter, it can lead to:
- Hydronephrosis (swelling of the kidney)
- Infection or, in rare cases, sepsis
This is why ongoing follow-up is essential during MET. Any signs of fever, worsening pain, or nausea should be reported right away.
4. Risk of Treatment Failure
Despite proper medication and hydration, some stones simply do not pass. If the stone does not progress or symptoms worsen, we may recommend minimally invasive surgical options to remove it safely.
Will I Still Need a Procedure Later?
Not necessarily. If MET is successful, you may never need a procedure. However, some stones do not pass despite medication, and in those cases, we will discuss next steps, including minimally invasive surgical options.
We will also work with you to prevent future stones with a tailored metabolic evaluation and prevention plan.
Why Choose Fore River Urology?
- Timely evaluation and access to imaging
- In-office medical management and follow-up
- Clear guidance on when to escalate to a procedure
- Located in South Portland, Maine, serving patients statewide
Schedule a Consultation
If you’re experiencing a kidney stone, our team can determine whether medical expulsive therapy is a safe and effective option for you.
