For distal ureteral stones less than 10 mm, which regimens are recommended?

• A. Nifedipine with steroids
• B. Tamsulosin
• C. Nifedipine with steroids OR Tamsulosin
• D. Extracorporeal shock wave lithotripsy

Answer: (C)

Medical expulsive therapy is used for small distal ureteral stones to increase the chance and speed of spontaneous passage. Tamsulosin, an alpha-1 blocker, relaxes the smooth muscle of the distal ureter, reducing spasm and allowing the stone to pass more easily. Nifedipine, a calcium channel blocker, also relaxes ureteral smooth muscle to aid passage. Some regimens combine this approach with a short course of steroids to reduce inflammation and edema around the stone, potentially helping passage and easing pain. Because either tamsulosin or nifedipine with steroids can improve passage rates for distal stones under 10 mm, using one of these MET regimens is recommended. Extracorporeal shock wave lithotripsy is more invasive and generally reserved for stones that do not pass with MET or for larger stones, so it isn’t the first choice for small distal stones.