A WORLDWIDE PERSPECTIVE

AMONG EXPERTS
INTRODUCTION
Medical expulsive therapy (MET) assist
the spontaneous passage ureteral calculi
INTRODUCTION
PMET drugs presumed ureteral calculi
during pregnancy has not been studied
safety and utility are unknown
Selective
MATERIAL AND METOD

9 question survey worldwide membership Endourology

Society & AUA
survey delivered society administered e-mail lists to
registered active members.
instrument administered University of Wisconsin-
licensed Qualtrics survey system (Provo, UT).
No individual data gathered configured to prevent
answer revision one survey per electronic device to
prevent readministration.
survey went live (May 4, 2015 - June 6, 2015) Qualtrics
data analysis
MATERIAL AND METOD

Questions assessed
worldwide geographic location and size
type of practice
degree of training
specialization in stone disease care, and
interval since training completion
use or nonuse of MET and P-MET,
preferred pharmacologic MET/ P-MET agents,
reasoning for nonuse
physicianreported perception of malpractice risk
environment.
RESULT
RESULT
RESULT
564 worldwide survey mean survey completion
time 2 minutes & dropout rate 3%.
289 (52%) completed Endourology fellowship
training or specifically focusing their practices on
urologic stone disease
90% using MET convenient or routinely adult
patient.
MET in nonpregnant adults high and not
influenced by region, training, time in practice,
specialization, or practice type.
RESULT
Expert practitioners less to utilize P-MET than
nonexperts this difference failed statistical
significance ( p = 0.06).
P-MET in AUA
prescribe 27.3%
dispensing 71.8%.
worldwide the time from training, degree of
specialization in stone care, and practice type
not to significantly interact with adoption of P-MET.
RESULT
RESULT
P-MET
1st tamsulosin 89.3% (Category B)
2nd Calcium channel blockers 7.3% (Category C)
3rd alfuzosin 6.9%(Category B)
reasons for rejecting PMET
adverse outcome 76.7%
legal risk 52.8%
safety 23.9%
influenced by local obstetrician 15.6%
felt P-MET ineffective 7.6% slightly higher 2.4% not using MET
in nonpregnant adults.
RESULT
perception medicolegal risk on average risk
55.4% not associated with a decreased
usage P-MET ( p = 0.21)
American urologists (65%)high risk US
medicolegally
US urologists rarely or never using P-MET
154 of 323 (47.7%) those regions US,
avoidance P-MET perception of high legal
risk.
DISCUSSION

effectiveness P-MET is unknown

progesterone-mediated physiologic
relaxation ureter occurs in pregnancy.
alpha blockade and calcium blocker not
significant benefit smooth muscle
deactivation.
Risks are unknown & safety poorly studied in
pregnancy.
DISCUSSION
super-selective alpha blockers tamsulosin and alfuzosin
Pregnancy Category B
nonselective alpha blockers terazosin and doxazosin,
calcium channel blockers, and glucocorticoid
Pregnancy Category C
uterus contain receptors for alphaadrenergic agonists
impact of blockers active gravid state is unknown.
Calcium channel blockers delay the initiation of labor
in animal and in vitro human models, as does alpha
blockade.
DISCUSSION
Prescriber pregnancy category as a guide difficult
to assess in this study.
tamsulosin and alfuzosin are Pregnancy Category B
all others are Pregnancy Category C
worldwide MET practice types, intervals from
training, and involvement with stone care and region.
MET usage not been previously assessedon this
sample of urologists high and uniform.
P-MET fewer practitioners tamsulosin, not
appear modulated by those factors.
DISCUSSION
variation P-MET no associated factors
lower.
DISCUSSION
majority (59.6%) of endourology-trained or
stone-focused practitioners do not dispense
P-MET.
Bias choosing to respond to surveys
practitioners with different practice patterns
than nonresponders.
influenced by fear of negative outcomes in P-
MET utility of this therapy in facilitating
stone passageare unclear