External validation of the medical expulsive therapy stone score (METSS) for predicting spontaneous passage in proximal and mid-ureteral stones
Abstract
Abstract
Objective: The medical expulsive therapy stone score (METSS) was developed to assess the success of MET in distal ureteral stones. In this study, we aimed to perform an external validation of the METSS to estimate spontaneous passage in patients with proximal and mid-ureteral stones.
Materials and methods: We retrospectively analyzed 62 adult patients with 4-10 mm proximal or mid-ureteral stones treated with medical expulsive therapy (MET) between September 2022 and June 2024. MET consisted of silodosin (4 mg) once daily. Patients were followed weekly for up to four weeks to assess stone passage. METSS scores were calculated, and treatment outcomes were compared.
Results: Spontaneous stone passage occurred in 53.7% of the 54 patients who completed the study. Stone size, stone burden, and the METSS score were significantly associated with treatment outcomes. Patients with lower METSSs had higher stone passage rates. The area under the ROC curve (AUROC) for the METSS was 0.674 (p=0.029). The METSS score demonstrated a sensitivity of 76% and specificity of 56%, indicating moderate predictive performance.
Conclusion: The METSS scoring system has a moderate ability to predict the spontaneous passage of proximal and mid-ureteral stones. Nevertheless, it may assist clinicians in making informed decisions between conservative and interventional treatment strategies.
Ethical Statement
This study received ethical approval from the Institutional Review Board of Adnan Menderes University, with reference number 2025/66.
Project Number
2025/66
References
- Trinchieri A, Coppi F, Montanari E, Del Nero A, Zanetti G, Pisani E. Increase in the prevalence of symptomatic upper urinary tract stones during the last ten years. Eur Urol. 2000;37(1):23-25. doi:10.1159/000020094
- Pak CY. Kidney stones. Lancet. 1998;351(9118):1797-1801. doi:10.1016/S0140-6736(98)01295-1
- Bahçeci T, Başer A. Comparison the efficacy of pneumatic and holmium laser ureteroscopic lithotripsy for the treatment of ureteral stones: a retrospective observational study. Pam Tıp Derg. 2022;15(4):648-655. doi:10.31362/patd.1055563
- Aras B, Alkiş O, İvelik Hİ, Sevim M, Başer A. Holmium laser lithotripsy with semirigid ureterorenoscopy in treatment of upper ureteral and renal pelvis stones under spinal anesthesia. JCU 2020;15(3):224-228. doi:10.1177/2051415820956432
- Liu H, Wang S, Zhu W, Lu J, Wang X, Yang W. Comparative efficacy of 22 drug interventions as medical expulsive therapy for ureteral stones: a systematic review and network meta-analysis. Urolithiasis. 2020;48(5):447-457. doi:10.1007/s00240-019-01159-5
- Türk C, Petřík A, Sarica K, et al. EAU Guidelines on Diagnosis and Conservative Management of Urolithiasis. Eur Urol. 2016;69(3):468-474. doi:10.1016/j.eururo.2015.07.040
- Aghaways I, Ibrahim R, Bapir R, Salih RQ, Salih KM, Abdulla BA. The role of inflammatory serum markers and ureteral wall thickness on spontaneous passage of ureteral stone < 10 mm: a prospective cohort study. Ann Med Surg (Lond). 2022;80:104198. doi:10.1016/j.amsu.2022.104198
- Hollingsworth JM, Canales BK, Rogers MA, et al. Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis. BMJ. 2016;355:i6112. doi:10.1136/bmj.i6112
- Uzun E, Arabaci HB, Ceviz K, Koudonas A, Germiyanoglu RC, Senel S. Development of a new scoring system predicting medical expulsive therapy success on 4-10 mm distal ureteral stones: medical expulsive therapy stone score (METSS). Urolithiasis. 2023;52(1):8. doi:10.1007/s00240-023-01504-9
- Sharma G, Pareek T, Kaundal P, et al. Comparison of efficacy of three commonly used alpha-blockers as medical expulsive therapy for distal ureter stones: A systematic review and network meta-analysis. Int Braz J Urol. 2022;48(5):742-759. doi:10.1590/S1677-5538.IBJU.2020.0548
- Abdelaal MA, El Dydamony EM. Comparative study between Tamsulosin, Silodosin and Tadalafil as a medical expulsive therapy for lower ureteral stones. Arch Ital Urol Androl. 2023;95(1):10849. doi:10.4081/aiua.2023.10849
- Abdel Kader MS, Sayed AM, Sayed SM, AbdelRazek M. Evaluation of the efficacy and safety of either or both mirabegron and silodosin, as a medical expulsive therapy for distal ureteric stones. Int Urol Nephrol. 2024;56(5):1605-1610. doi:10.1007/s11255-023-03880-y
- Abdullah A, Basoo Gupta Y, Selvaraj S, et al. A Comparison Between Silodosin and Tamsulosin for Medical Expulsive Therapy of Distal Ureteric Calculus. Cureus. 2023;15(10):e47008. doi:10.7759/cureus.47008
- Faridi MS, Deshpande S. Comparing silodosin and mirabegron as medical expulsive therapy for distal ureteral calculus: a prospective, randomized study. Cent European J Urol. 2024;77(2):286-290. doi:10.5173/ceju.2023.182
- Selvi I, Baydilli N, Tokmak TT, Akinsal EC, Basar H. CT-related parameters and Framingham score as predictors of spontaneous passage of ureteral stones ≤ 10 mm: results from a prospective, observational, multicenter study. Urolithiasis. 2021;49(3):227-237. doi:10.1007/s00240-020-01214-6
- Khan RU, Nazim SM, Anwar S. CT-Based Predictors of Spontaneous Ureteral Stone Passage. J Coll Physicians Surg Pak. 2024;34(8):879-884. doi:10.29271/jcpsp.2024.08.879
- Shah TT, Gao C, Peters M, et al. Factors associated with spontaneous stone passage in a contemporary cohort of patients presenting with acute ureteric colic: results from the Multicenter cohort study evaluating the role of Inflammatory Markers In patients presenting with acute ureteric Colic (MIMIC) study. BJU Int. 2019;124(3):504-513. doi:10.1111/bju.14777
- Ibrahim AK, Mahmood IH, Mahmood NS. Efficacy and safety of tamsulosin vs. alfuzosin as medical expulsive therapy for ureteric stones. Arab J Urol. 2013;11(2):142-147. doi:10.1016/j.aju.2013.02.003
- Çelik S, Akdeniz F, Afsar Yildirim M, et al. Tadalafil versus alpha blockers (alfuzosin, doxazosin, tamsulosin and silodosin) as medical expulsive therapy for < 10 mm distal and proximal ureteral stones. Arch Ital Urol Androl. 2018;90(2):117-122. doi:10.4081/aiua.2018.2.117
- Moon YJ, Kim HW, Kim JB, Kim HJ, Chang YS. Distribution of ureteral stones and factors affecting their location and expulsion in patients with renal colic. Korean J Urol. 2015;56(10):717-721. doi:10.4111/kju.2015.56.10.717
- Itoh Y, Kojima Y, Yasui T, Tozawa K, Sasaki S, Kohri K. Examination of alpha 1 adrenoceptor subtypes in the human ureter. Int J Urol. 2007;14(8):749-753. doi:10.1111/j.1442-2042.2007.01812.x
- Ramasamy V, Aarthy P, Sharma V, Thakur APS. Role of inflammatory markers and their trends in predicting the outcome of medical expulsive therapy for distal ureteric calculus. Urol Ann. 2022;14(1):8-14. doi:10.4103/ua.ua_139_21
- Gao C, Peters M, Kurver P, et al. BURST Collaborative MIMIC Study Group. Nomogram predicting the probability of spontaneous stone passage in patients presenting with acute ureteric colic. BJU Int. 2022;130(6):823-831. doi:10.1111/bju.15839
Proksimal ve orta üreter taşlarında medikal ekspulsif terapi taş skoru (METSS) sisteminin dış validasyonu
Abstract
Amaç: Medical Expulsive Therapy Stone Score (METSS), distal üreter taşlarında medikal ekspulsif tedavinin (MET) başarısını değerlendirmek amacıyla geliştirilmiştir. Bu çalışmada, METSS sisteminin proksimal ve orta üreter taşlarına sahip hastalarda spontan geçişi öngörme açısından dış doğrulamasını yapmayı amaçladık.
Gereç ve yöntem: Eylül 2022-Haziran 2024 arasında, 4-10 mm boyutlarında proksimal veya orta üreter taşı olan 62 erişkin hastanın verileri retrospektif olarak incelendi. Hastalara günlük 4 mg silodosin içeren medikal ekspulsif tedavi (MET) uygulandı. Taş geçişi açısından hastalar 4 hafta boyunca takip edildi. METSS skorları hesaplanarak tedavi sonuçlarıyla karşılaştırıldı.
Bulgular: Çalışmayı tamamlayan 54 hastanın %53,7’sinde spontan taş geçişi sağlandı. Taş boyutu, taş yükü ve METSS skorları ile tedavi başarısı arasında anlamlı ilişki bulundu. Düşük METSS skoru olan hastalarda taş geçiş oranı daha yüksekti. METSS için ROC eğrisi altında kalan alan 0,674 idi (p=0,029). METSS skoru %76 duyarlılık (sensitivite) ve %56 özgüllük (spesifite) ile orta düzeyde bir prediktif performans sergilemiştir.
Sonuç: METSS skorlama sistemi, proksimal ve orta üreter taşlarının spontan geçişini öngörmede orta düzeyde prediktif güce sahiptir. Buna rağmen, konservatif ve girişimsel tedavi seçenekleri arasında karar verme sürecinde klinisyenlere rehberlik edebilir.
Project Number
2025/66
References
- Trinchieri A, Coppi F, Montanari E, Del Nero A, Zanetti G, Pisani E. Increase in the prevalence of symptomatic upper urinary tract stones during the last ten years. Eur Urol. 2000;37(1):23-25. doi:10.1159/000020094
- Pak CY. Kidney stones. Lancet. 1998;351(9118):1797-1801. doi:10.1016/S0140-6736(98)01295-1
- Bahçeci T, Başer A. Comparison the efficacy of pneumatic and holmium laser ureteroscopic lithotripsy for the treatment of ureteral stones: a retrospective observational study. Pam Tıp Derg. 2022;15(4):648-655. doi:10.31362/patd.1055563
- Aras B, Alkiş O, İvelik Hİ, Sevim M, Başer A. Holmium laser lithotripsy with semirigid ureterorenoscopy in treatment of upper ureteral and renal pelvis stones under spinal anesthesia. JCU 2020;15(3):224-228. doi:10.1177/2051415820956432
- Liu H, Wang S, Zhu W, Lu J, Wang X, Yang W. Comparative efficacy of 22 drug interventions as medical expulsive therapy for ureteral stones: a systematic review and network meta-analysis. Urolithiasis. 2020;48(5):447-457. doi:10.1007/s00240-019-01159-5
- Türk C, Petřík A, Sarica K, et al. EAU Guidelines on Diagnosis and Conservative Management of Urolithiasis. Eur Urol. 2016;69(3):468-474. doi:10.1016/j.eururo.2015.07.040
- Aghaways I, Ibrahim R, Bapir R, Salih RQ, Salih KM, Abdulla BA. The role of inflammatory serum markers and ureteral wall thickness on spontaneous passage of ureteral stone < 10 mm: a prospective cohort study. Ann Med Surg (Lond). 2022;80:104198. doi:10.1016/j.amsu.2022.104198
- Hollingsworth JM, Canales BK, Rogers MA, et al. Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis. BMJ. 2016;355:i6112. doi:10.1136/bmj.i6112
- Uzun E, Arabaci HB, Ceviz K, Koudonas A, Germiyanoglu RC, Senel S. Development of a new scoring system predicting medical expulsive therapy success on 4-10 mm distal ureteral stones: medical expulsive therapy stone score (METSS). Urolithiasis. 2023;52(1):8. doi:10.1007/s00240-023-01504-9
- Sharma G, Pareek T, Kaundal P, et al. Comparison of efficacy of three commonly used alpha-blockers as medical expulsive therapy for distal ureter stones: A systematic review and network meta-analysis. Int Braz J Urol. 2022;48(5):742-759. doi:10.1590/S1677-5538.IBJU.2020.0548
- Abdelaal MA, El Dydamony EM. Comparative study between Tamsulosin, Silodosin and Tadalafil as a medical expulsive therapy for lower ureteral stones. Arch Ital Urol Androl. 2023;95(1):10849. doi:10.4081/aiua.2023.10849
- Abdel Kader MS, Sayed AM, Sayed SM, AbdelRazek M. Evaluation of the efficacy and safety of either or both mirabegron and silodosin, as a medical expulsive therapy for distal ureteric stones. Int Urol Nephrol. 2024;56(5):1605-1610. doi:10.1007/s11255-023-03880-y
- Abdullah A, Basoo Gupta Y, Selvaraj S, et al. A Comparison Between Silodosin and Tamsulosin for Medical Expulsive Therapy of Distal Ureteric Calculus. Cureus. 2023;15(10):e47008. doi:10.7759/cureus.47008
- Faridi MS, Deshpande S. Comparing silodosin and mirabegron as medical expulsive therapy for distal ureteral calculus: a prospective, randomized study. Cent European J Urol. 2024;77(2):286-290. doi:10.5173/ceju.2023.182
- Selvi I, Baydilli N, Tokmak TT, Akinsal EC, Basar H. CT-related parameters and Framingham score as predictors of spontaneous passage of ureteral stones ≤ 10 mm: results from a prospective, observational, multicenter study. Urolithiasis. 2021;49(3):227-237. doi:10.1007/s00240-020-01214-6
- Khan RU, Nazim SM, Anwar S. CT-Based Predictors of Spontaneous Ureteral Stone Passage. J Coll Physicians Surg Pak. 2024;34(8):879-884. doi:10.29271/jcpsp.2024.08.879
- Shah TT, Gao C, Peters M, et al. Factors associated with spontaneous stone passage in a contemporary cohort of patients presenting with acute ureteric colic: results from the Multicenter cohort study evaluating the role of Inflammatory Markers In patients presenting with acute ureteric Colic (MIMIC) study. BJU Int. 2019;124(3):504-513. doi:10.1111/bju.14777
- Ibrahim AK, Mahmood IH, Mahmood NS. Efficacy and safety of tamsulosin vs. alfuzosin as medical expulsive therapy for ureteric stones. Arab J Urol. 2013;11(2):142-147. doi:10.1016/j.aju.2013.02.003
- Çelik S, Akdeniz F, Afsar Yildirim M, et al. Tadalafil versus alpha blockers (alfuzosin, doxazosin, tamsulosin and silodosin) as medical expulsive therapy for < 10 mm distal and proximal ureteral stones. Arch Ital Urol Androl. 2018;90(2):117-122. doi:10.4081/aiua.2018.2.117
- Moon YJ, Kim HW, Kim JB, Kim HJ, Chang YS. Distribution of ureteral stones and factors affecting their location and expulsion in patients with renal colic. Korean J Urol. 2015;56(10):717-721. doi:10.4111/kju.2015.56.10.717
- Itoh Y, Kojima Y, Yasui T, Tozawa K, Sasaki S, Kohri K. Examination of alpha 1 adrenoceptor subtypes in the human ureter. Int J Urol. 2007;14(8):749-753. doi:10.1111/j.1442-2042.2007.01812.x
- Ramasamy V, Aarthy P, Sharma V, Thakur APS. Role of inflammatory markers and their trends in predicting the outcome of medical expulsive therapy for distal ureteric calculus. Urol Ann. 2022;14(1):8-14. doi:10.4103/ua.ua_139_21
- Gao C, Peters M, Kurver P, et al. BURST Collaborative MIMIC Study Group. Nomogram predicting the probability of spontaneous stone passage in patients presenting with acute ureteric colic. BJU Int. 2022;130(6):823-831. doi:10.1111/bju.15839
Details
| Primary Language | English |
|---|---|
| Subjects | Urology |
| Journal Section | Research Article |
| Authors | |
| Project Number | 2025/66 |
| Early Pub Date | July 11, 2025 |
| Publication Date | |
| Submission Date | May 3, 2025 |
| Acceptance Date | July 11, 2025 |
| Published in Issue | Year 2025 Volume: 18 Issue: 4 |
