{"id":4227,"date":"2021-10-01T08:00:00","date_gmt":"2021-10-01T01:00:00","guid":{"rendered":"https:\/\/drsoaraweeurology.com\/?p=4227"},"modified":"2026-08-22T05:39:52","modified_gmt":"2026-08-21T22:39:52","slug":"%d8%b7%d8%b1%d8%af-%d8%ad%d8%b5%d9%88%d8%a7%d8%aa-%d8%a7%d9%84%d8%ad%d8%a7%d9%84%d8%a8-%d8%b7%d8%a8%d9%8a%d8%a7","status":"publish","type":"post","link":"https:\/\/drsoaraweeurology.com\/ar\/2021\/10\/01\/medical-ureteric-stone-expulsive\/","title":{"rendered":"Waiting for a Stone to Pass: Does Medication Actually Help?"},"content":{"rendered":"\n<div class=\"wp-block-columns coblocks-author-columns has-background is-layout-flex wp-container-core-columns-is-layout-52275889 wp-block-columns-is-layout-flex\" style=\"background-color:#8C8C971A;padding-top:2.5rem;padding-right:2.5rem;padding-bottom:2.5rem;padding-left:2.5rem\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:25%\">\n<figure class=\"wp-block-image size-full is-style-rounded\"><img data-recalc-dims=\"1\" fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"800\" data-attachment-id=\"7037\" data-permalink=\"https:\/\/drsoaraweeurology.com\/ar\/new-photo-2024\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" data-orig-size=\"800,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=800%2C800&#038;ssl=1\" alt=\"Best Urologist working in Chonburi and Cambodia\" class=\"wp-image-7037\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?w=800&amp;ssl=1 800w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=300%2C300&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=150%2C150&amp;ssl=1 150w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=768%2C768&amp;ssl=1 768w, 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target=\"_blank\" rel=\"noreferrer noopener\">Bangkok hospital Headquarter, Bangkok<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"tel:+66880221445\" target=\"_blank\" rel=\"noreferrer noopener\">Samitivej Sriracha Hospital \u2014 Urology department: <strong>088-022-1445<\/strong><\/a><\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button is-style-outline is-style-outline--1\"><a class=\"wp-block-button__link has-background-background-color has-text-color has-background has-link-color has-small-font-size has-custom-font-size wp-element-button\" href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" style=\"color:#1b4965\" target=\"_blank\" rel=\"noreferrer noopener\">Book a Consultation<\/a><\/div>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<ul class=\"wp-block-social-links aligncenter has-normal-icon-size is-style-default 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2.578-2.016 5.025-5.325 5.025h-3.919V7.416zm1.444 1.303v7.444h2.297c3.272 0 4.022-2.484 4.022-3.722 0-2.016-1.284-3.722-4.097-3.722h-2.222z\"\/>\n    <\/svg>\n  <\/a>\n  \n  <a href=\"https:\/\/scholar.google.com\/citations?user=lTgsRMUAAAAJ&#038;hl=en\" \n     target=\"_blank\" \n     rel=\"noopener\"\n     title=\"Google Scholar\"\n     aria-label=\"View Google Scholar Profile\"\n     style=\"text-decoration: none; color: #4285F4; transition: transform 0.2s; display: inline-block;\"\n     onmouseover=\"this.style.transform='scale(1.15)'\"\n     onmouseout=\"this.style.transform='scale(1)'\">\n    <svg width=\"28\" height=\"28\" viewBox=\"0 0 24 24\" fill=\"currentColor\">\n      <path d=\"M5.242 13.769L0.5 9.5 12 1l11.5 8.5-4.742 4.269C17.548 11.249 14.978 9.5 12 9.5c-2.977 0-5.548 1.748-6.758 4.269zM12 10a7 7 0 1 0 0 14 7 7 0 0 0 0-14z\"\/>\n    <\/svg>\n  <\/a>\n  \n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Most people with a small ureteric stone would rather wait for it to pass than have an operation, and most of the time that is a reasonable plan. The question that follows is whether a tablet can improve the odds. This is called <strong>medical expulsive therapy<\/strong>, and the honest answer has changed since this article was first written.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Urology center Bangkok hospital Thailand\u00a0<a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Booking online<\/a>\u00a0<a href=\"tel:02-310-3009\">02-310-3009<\/a>\u00a0<a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a><\/li>\n\n\n\n<li>Samitivej Sriracha hospital Chonburi&nbsp;<a href=\"tel:088-022-1445\">088-022-1445<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">First: Waiting Is Only an Option If It Is Safe to Wait<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Nothing below applies if any of these are present. They mean the stone is dealt with now, not watched:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Fever or chills with the pain<\/strong> \u2014 a blocked kidney that is also infected needs urgent drainage, and antibiotics alone will not do it<\/li>\n\n\n\n<li><strong>Pain that painkillers do not control<\/strong>, or repeated attacks<\/li>\n\n\n\n<li><strong>Vomiting that stops you keeping fluids or tablets down<\/strong><\/li>\n\n\n\n<li><strong>Both kidneys obstructed, a single kidney, a transplanted kidney, or deteriorating kidney function<\/strong><\/li>\n\n\n\n<li><strong>Pregnancy<\/strong><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Attend an emergency department, or call <strong>1669<\/strong> in Thailand. The symptom list is set out more fully in <a href=\"https:\/\/drsoaraweeurology.com\/2021\/09\/24\/ureteric-stone-pain-management\/\">ureteric stone pain: what helps and what cannot wait<\/a>.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"4216\" data-permalink=\"https:\/\/drsoaraweeurology.com\/ar\/team-of-surgeons-performing-operation-in-operation-theater-at-hospital-2\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Operation.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;3.2&quot;,&quot;credit&quot;:&quot;Wavebreak Media LTD&quot;,&quot;camera&quot;:&quot;Canon EOS 5D Mark III&quot;,&quot;caption&quot;:&quot;Team of surgeons performing operation in operation theater at hospital&quot;,&quot;created_timestamp&quot;:&quot;1468061655&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;35&quot;,&quot;iso&quot;:&quot;400&quot;,&quot;shutter_speed&quot;:&quot;0.005&quot;,&quot;title&quot;:&quot;Team of surgeons performing operation in operation theater at hospital&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Medical expulsive therapy has a chance to avoid Emergency endoscopic stone removal procedure.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Medical expulsive therapy has a chance to avoid Emergency endoscopic stone removal procedure.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Operation.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Operation.jpg?resize=800%2C533&#038;ssl=1\" alt=\"Urological operating theatre \u2014 ureteroscopy is the alternative when a ureteric stone will not pass or must be dealt with urgently\" class=\"wp-image-4216\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Operation.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Operation.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Operation.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Operation.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Operation.jpg?resize=18%2C12&amp;ssl=1 18w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Waiting is a choice between two reasonable options \u2014 not a way of avoiding an operation at any cost.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">How Likely Is It to Pass on Its Own?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Two things decide it: <strong>how big the stone is, and how far down it already is.<\/strong> Broadly, and these are approximate figures rather than promises:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Stones under about <strong>5 mm<\/strong> pass spontaneously in roughly two-thirds of people; stones between <strong>5 and 10 mm<\/strong> in something closer to half<\/li>\n\n\n\n<li>A stone already in the <strong>lower ureter<\/strong>, near the bladder, passes far more often than one still high up near the kidney \u2014 roughly three-quarters against about half<\/li>\n\n\n\n<li>Above about 10 mm, spontaneous passage becomes unlikely and waiting mostly buys pain rather than time<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"4217\" data-permalink=\"https:\/\/drsoaraweeurology.com\/ar\/a-paper-model-of-a-human-kidney-with-sand-and-stone-a-stethoscope-and-a-jar-of-urine-tests-on-a-blue-background-kidney-health-concept\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Ureteric-stone.jpg?fit=5000%2C3333&amp;ssl=1\" data-orig-size=\"5000,3333\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;14&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;Canon EOS R&quot;,&quot;caption&quot;:&quot;a paper model of a human kidney with sand and stone, a stethoscope and a jar of urine tests on a blue background. kidney health concept&quot;,&quot;created_timestamp&quot;:&quot;1614593445&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;45&quot;,&quot;iso&quot;:&quot;250&quot;,&quot;shutter_speed&quot;:&quot;0.4&quot;,&quot;title&quot;:&quot;a paper model of a human kidney with sand and stone, a stethoscope and a jar of urine tests on a blue background. kidney health concept&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Chance of passing stone is depended on several factors &amp;#8211; size of stone, location of obstructed stone.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Chance of passing stone is depended on several factors &amp;#8211; size of stone, location of obstructed stone.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Ureteric-stone.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Ureteric-stone.jpg?resize=800%2C533&#038;ssl=1\" alt=\"Diagram showing a stone in the ureter \u2014 the chance of spontaneous passage depends on stone size and how far down the ureter it sits\" class=\"wp-image-4217\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Ureteric-stone.jpg?w=5000&amp;ssl=1 5000w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Ureteric-stone.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Ureteric-stone.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Ureteric-stone.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Ureteric-stone.jpg?resize=1536%2C1024&amp;ssl=1 1536w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Ureteric-stone.jpg?resize=2048%2C1365&amp;ssl=1 2048w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Ureteric-stone.jpg?resize=18%2C12&amp;ssl=1 18w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Ureteric-stone.jpg?resize=1200%2C800&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Ureteric-stone.jpg?resize=1568%2C1045&amp;ssl=1 1568w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Ureteric-stone.jpg?w=2400&amp;ssl=1 2400w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Size and position together decide the odds; the CT gives both.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">A Correction: What the Tablet Really Does<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">An earlier version of this article stated that medical expulsive therapy increases the passage rate by about 29% and attributed that figure to US and European guidelines. <strong>That overstates it considerably, and it is corrected here.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Early studies were small and enthusiastic. Then two large, properly blinded, placebo-controlled randomised trials tested alpha blockers in this setting and found <strong>no overall benefit<\/strong> \u2014 people given the drug passed their stones no more often than people given a dummy tablet. Subsequent analysis pooling the evidence found the benefit is real but <strong>narrow<\/strong>: it appears in <strong>larger stones, above about 5 mm, sitting in the lower ureter<\/strong>, and it is hard to demonstrate at all in small stones \u2014 which is unsurprising, since most of those pass anyway.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">That is why current guidance is phrased as <em>may be offered<\/em> for larger distal stones rather than as a routine addition for everyone. It is worth taking in the right situation, and it is not the difference between an operation and no operation in most people. It is also, in most countries, an <strong>off-label<\/strong> use of a drug licensed for the prostate \u2014 which is perfectly normal practice, but you are entitled to know it.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">The Side Effects You Should Be Told About<\/h2>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"4218\" data-permalink=\"https:\/\/drsoaraweeurology.com\/ar\/people-emotions-lifestyle-and-fashion-concept-distressed-and-exhausted-asian-woman-close-eyes-and-touching-temples-having-migraine-feeling-headache-or-dizzy-yellow-background\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Dizziness.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;5.6&quot;,&quot;credit&quot;:&quot;Seva Levitsky&quot;,&quot;camera&quot;:&quot;Canon EOS 5D Mark III&quot;,&quot;caption&quot;:&quot;People emotions, lifestyle and fashion concept. Distressed and exhausted asian woman close eyes and touching temples, having migraine, feeling headache or dizzy, yellow background.&quot;,&quot;created_timestamp&quot;:&quot;1591630852&quot;,&quot;copyright&quot;:&quot;Cookie Studio 2017&quot;,&quot;focal_length&quot;:&quot;70&quot;,&quot;iso&quot;:&quot;100&quot;,&quot;shutter_speed&quot;:&quot;0.00625&quot;,&quot;title&quot;:&quot;People emotions, lifestyle and fashion concept. Distressed and exhausted asian woman close eyes and touching temples, having migraine, feeling headache or dizzy, yellow background&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"4% of Dizziness was reported during medical expulsive therapy.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;4% of Dizziness was reported during medical expulsive therapy.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Dizziness.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Dizziness.jpg?resize=800%2C533&#038;ssl=1\" alt=\"A man feeling dizzy on standing \u2014 light-headedness from a drop in blood pressure is the commonest alpha blocker side effect\" class=\"wp-image-4218\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Dizziness.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Dizziness.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Dizziness.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Dizziness.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Dizziness.jpg?resize=18%2C12&amp;ssl=1 18w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Light-headedness on standing is the commonest effect, and it is worst with the first doses.<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Alpha blockers relax smooth muscle, which is how they help the ureter \u2014 and also why they do the following:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Light-headedness or dizziness on standing<\/strong>, from a drop in blood pressure. Worst with the first few doses, which is why they are usually taken at night. Stand up slowly.<\/li>\n\n\n\n<li><strong>Changes in ejaculation<\/strong> \u2014 reduced volume, or semen going backwards into the bladder rather than outwards. Men are frequently not warned about this and find it alarming. It is not dangerous and it reverses when the drug is stopped, but nobody should discover it by surprise.<\/li>\n\n\n\n<li><strong>Interaction with erectile dysfunction tablets.<\/strong> Both lower blood pressure, and taken together they can drop it too far. Tell your doctor if you take one.<\/li>\n\n\n\n<li><strong>Cataract surgery.<\/strong> Alpha blockers can cause <em>intraoperative floppy iris syndrome<\/em>, which makes cataract surgery more difficult. If you have ever taken one, tell your eye surgeon \u2014 even years later. This matters more than the dizziness and is almost never mentioned.<\/li>\n\n\n\n<li>Headache, blocked nose, and a temporary increase in pain as the stone starts moving.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Do not take these tablets on your own.<\/strong> Not because they are exotic, but because taking them means committing to a period of waiting \u2014 and waiting is only safe when someone is checking that the kidney is not quietly being damaged.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">How Long Is It Safe to Keep Waiting?<\/h2>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"534\" data-attachment-id=\"4220\" data-permalink=\"https:\/\/drsoaraweeurology.com\/ar\/doctor-checking-x-ray-results-3\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Parameters.jpg?fit=1200%2C801&amp;ssl=1\" data-orig-size=\"1200,801\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;Doctor checking x-ray results&quot;,&quot;created_timestamp&quot;:&quot;1498572884&quot;,&quot;copyright&quot;:&quot;Rawpixel Ltd.&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;200&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;Doctor checking x-ray results&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"After carefully assess ureteric stone from CT scan, attending urologist can consider choice of medical expulsive therapy in specific patients.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;After carefully assess ureteric stone from CT scan, attending urologist can consider choice of medical expulsive therapy in specific patients.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Parameters.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Parameters.jpg?resize=800%2C534&#038;ssl=1\" alt=\"CT images used to measure a ureteric stone \u2014 size, position and ureteric appearance guide whether waiting is reasonable\" class=\"wp-image-4220\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Parameters.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Parameters.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Parameters.jpg?resize=1024%2C684&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Parameters.jpg?resize=768%2C513&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/09\/Parameters.jpg?resize=18%2C12&amp;ssl=1 18w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Follow-up imaging is what turns waiting into a plan rather than a hope.<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">This is the question the original article never answered, and it is the most important one. A trial of waiting is generally reviewed at around <strong>four to six weeks<\/strong>, with imaging \u2014 usually an ultrasound \u2014 to see whether the stone has moved and whether the kidney is still swollen. Beyond roughly that window, prolonged obstruction begins to risk <strong>permanent loss of function in that kidney<\/strong>, and the balance tips towards treating the stone.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">And here is the trap that makes follow-up non-negotiable: <strong>the pain settling does not mean the stone has passed.<\/strong> A completely obstructed kidney often stops hurting, because the pressure stabilises. A man who feels better, never saw a stone come out, and quietly stops attending can lose that kidney over months without a single symptom. <strong>If you did not see the stone, you have not finished.<\/strong> Strain your urine, keep whatever appears, and keep the follow-up appointment either way.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If waiting does not work, the alternatives are shockwave treatment or ureteroscopy with the holmium laser \u2014 both set out on the <a href=\"https:\/\/drsoaraweeurology.com\/services\/kidney-stone-treatment-bangkok\/\">kidney stone treatment<\/a> page. Whatever happens, the stone that has just passed is the beginning of the next conversation rather than the end of this one: without prevention, the recurrence rate is high, and <a href=\"https:\/\/drsoaraweeurology.com\/2020\/06\/19\/8-good-habits-for-the-prevention-of-kidney-stones-formation\/\">the habits that prevent stones<\/a> are worth more than any tablet described here.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Frequently Asked Questions<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Does medication really help a ureteric stone pass?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Less than was once claimed. Early small studies were encouraging, but two large placebo-controlled randomised trials found no overall benefit from alpha blockers, and pooled analysis since suggests the benefit is confined to larger stones, above about 5 mm, sitting in the lower ureter. Current guidance therefore says it may be offered in that situation rather than routinely. It is a reasonable addition in the right patient, not the difference between surgery and no surgery for most people.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">What are the chances my stone passes by itself?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Roughly two-thirds for stones under about 5 mm and around half for those between 5 and 10 mm, with position mattering as much as size: a stone already low in the ureter near the bladder passes far more often than one still high up. Above about 10 mm spontaneous passage is unlikely. These are approximate figures from the literature rather than individual predictions, and the CT measurements are what the estimate is actually based on.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">What side effects do these tablets have?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Light-headedness on standing, particularly with the first doses, which is why they are usually taken at night; changes in ejaculation, including reduced volume or semen passing backwards into the bladder, which reverses on stopping; headache and blocked nose; and a temporary increase in pain as the stone moves. They also lower blood pressure alongside erectile dysfunction tablets, so tell your doctor if you take one. Importantly, they can cause floppy iris syndrome during cataract surgery, so tell your eye surgeon if you have ever taken one.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">How long can I safely wait for a stone to pass?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">A trial of waiting is usually reviewed at around four to six weeks with imaging. Beyond roughly that window, continued obstruction begins to risk permanent loss of function in that kidney and the balance shifts towards treating the stone. Waiting is a monitored plan with a review date, not an open-ended hope.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">My pain has stopped. Does that mean the stone passed?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Not necessarily, and this is the most dangerous assumption in the whole subject. A completely obstructed kidney frequently stops hurting once the pressure stabilises, so pain settling is not proof of anything. If you did not actually see a stone come out, the follow-up imaging still needs doing \u2014 a silently obstructed kidney can be lost over months without symptoms. Strain your urine and keep whatever appears, both as proof and for analysis.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">When should waiting be abandoned?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Immediately, if fever or chills develop, if pain cannot be controlled or keeps returning, if vomiting prevents keeping fluids down, or if urine output falls. Also if follow-up shows the stone has not moved, the kidney remains obstructed, or kidney function is deteriorating. In those situations the options are shockwave treatment or ureteroscopy.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Book an Appointment<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Dr. Soarawee Weerasopone treats kidney and ureteric stones at <a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Bangkok Hospital Headquarters<\/a> and at Samitivej Sriracha Hospital, Chonburi \u2014 Urology department <a href=\"tel:0880221445\">088-022-1445<\/a>. Questions about cost are answered by the hospital rather than by Dr. Soarawee \u2014 for Bangkok Hospital, by email to <a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a>. <strong>An acute attack, or fever with flank pain, means an emergency department rather than a clinic appointment.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Bangkok Hospital Telemedicine is available for patients who cannot attend in person, including international patients \u2014 arrange it in advance by email to the Urology department at <a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a>. It is useful for reviewing imaging you already have and deciding on a plan; follow-up imaging itself requires an in-person visit. Samitivej Sriracha is in-person only.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Disclaimer:<\/strong> This article is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is educational only, is not medical advice, and does not create a doctor\u2013patient relationship. It gives no medication doses, and expulsive therapy should not be started without assessment: choosing to wait is a decision that requires imaging beforehand and monitoring afterwards. Use of alpha blockers for this purpose is off-label in most countries. No diagnosis, prescription or individual medical advice is given through personal messaging channels or social media, and Dr. Soarawee operates no public social media account \u2014 any account offering private consultation in his name is fraudulent. Fever with flank pain, uncontrolled pain, or inability to pass urine means an emergency department, or 1669 in Thailand.<\/p>\n\n\n\n<script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\",\n  \"@graph\": [\n    {\n      \"@type\": \"MedicalWebPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/10\/01\/medical-ureteric-stone-expulsive\/#webpage\",\n      \"url\": \"https:\/\/drsoaraweeurology.com\/2021\/10\/01\/medical-ureteric-stone-expulsive\/\",\n      \"name\": \"Waiting for a Stone to Pass: Does Medication Actually Help?\",\n      \"description\": \"What the large randomised trials showed about medical expulsive therapy for ureteric stones, which stones actually benefit, the alpha blocker side effects including ejaculatory change and floppy iris syndrome, and how long a trial of waiting can safely continue.\",\n      \"inLanguage\": \"en\",\n      \"datePublished\": \"2021-10-01\",\n      \"dateModified\": \"2026-08-22\",\n      \"lastReviewed\": \"2026-08-22\",\n      \"specialty\": \"https:\/\/schema.org\/Urologic\",\n      \"isPartOf\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#website\" },\n      \"author\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"reviewedBy\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"publisher\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"medicalAudience\": { \"@type\": \"MedicalAudience\", \"audienceType\": \"Patient\" },\n      \"about\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/10\/01\/medical-ureteric-stone-expulsive\/#met\" },\n      \"disambiguatingDescription\": \"Corrected August 2026. An earlier version stated that medical expulsive therapy increases stone passage by approximately 29 per cent and attributed that to US and European guidelines. Large placebo-controlled randomised trials subsequently found no overall benefit, and the benefit demonstrable on pooled analysis is confined to larger stones in the distal ureter, which is why guidance is phrased as may be offered rather than as routine. Alpha blocker use for this indication is off-label in most countries. No medication doses are given.\"\n    },\n    {\n      \"@type\": \"MedicalTherapy\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/10\/01\/medical-ureteric-stone-expulsive\/#met\",\n      \"name\": \"Medical expulsive therapy for ureteric stones\",\n      \"description\": \"Use of an alpha blocker to relax ureteric smooth muscle during a monitored trial of spontaneous stone passage. Benefit is limited: large blinded placebo-controlled randomised trials found no overall effect, with pooled analysis suggesting benefit confined to stones larger than about 5 mm in the distal ureter. Off-label in most countries.\",\n      \"indication\": {\n        \"@type\": \"MedicalIndication\",\n        \"description\": \"Clinically stable patient with an obstructing ureteric stone considered likely to pass, adequate pain control, no infection and preserved renal function. Most appropriate for larger distal stones.\"\n      },\n      \"contraindication\": {\n        \"@type\": \"MedicalContraindication\",\n        \"description\": \"Fever or suspected infected obstruction requiring urgent decompression; uncontrolled or recurrent pain; intractable vomiting; bilateral obstruction, solitary or transplanted kidney, or deteriorating renal function; pregnancy. Self-medication without assessment and follow-up imaging is not appropriate.\"\n      },\n      \"adverseOutcome\": [\n        { \"@type\": \"MedicalEntity\", \"name\": \"Orthostatic hypotension and dizziness, greatest with initial doses\" },\n        { \"@type\": \"MedicalEntity\", \"name\": \"Ejaculatory dysfunction including reduced volume and retrograde ejaculation, reversible on stopping\" },\n        { \"@type\": \"MedicalEntity\", \"name\": \"Additive hypotension with PDE5 inhibitors\" },\n        { \"@type\": \"MedicalEntity\", \"name\": \"Intraoperative floppy iris syndrome during cataract surgery, which the ophthalmic surgeon must be told about even years after exposure\" },\n        { \"@type\": \"MedicalEntity\", \"name\": \"Headache, nasal congestion, and transient increase in pain as the stone moves\" }\n      ],\n      \"seriousAdverseOutcome\": [\n        { \"@type\": \"MedicalEntity\", \"name\": \"Silent persistent obstruction: pain frequently settles once pressure stabilises, and an unmonitored obstructed kidney can lose function over months without symptoms\" }\n      ],\n      \"followup\": \"Review at approximately four to six weeks with imaging, usually ultrasound, to confirm stone passage or movement and resolution of hydronephrosis. Prolonged obstruction beyond that window risks permanent loss of renal function. Resolution of pain does not confirm stone passage. Patients should strain urine and retain any stone for compositional analysis. Immediate reassessment for fever, uncontrolled pain, vomiting or reduced urine output; in Thailand the emergency number is 1669.\"\n    },\n    {\n      \"@type\": \"FAQPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/10\/01\/medical-ureteric-stone-expulsive\/#faq\",\n      \"isPartOf\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/10\/01\/medical-ureteric-stone-expulsive\/#webpage\" },\n      \"mainEntity\": [\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Does medication really help a ureteric stone pass?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"Less than was once claimed. Early small studies were encouraging, but two large placebo-controlled randomised trials found no overall benefit from alpha blockers, and pooled analysis since suggests benefit confined to larger stones, above about 5 mm, in the lower ureter. Guidance therefore says it may be offered in that situation rather than routinely.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"What are the chances a ureteric stone passes by itself?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"Roughly two-thirds for stones under about 5 mm and around half for those between 5 and 10 mm, with position mattering as much as size: a stone low in the ureter near the bladder passes far more often than one high up. Above about 10 mm spontaneous passage is unlikely. These are approximate literature figures rather than individual predictions.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"What side effects do alpha blockers have when used for stones?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"Light-headedness on standing, greatest with the first doses; changes in ejaculation including reduced volume or retrograde ejaculation, reversible on stopping; headache and nasal congestion; and a temporary increase in pain as the stone moves. They lower blood pressure additively with erectile dysfunction tablets. They can also cause intraoperative floppy iris syndrome during cataract surgery, so the eye surgeon should be told even years after exposure.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"How long is it safe to wait for a stone to pass?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"A trial of waiting is usually reviewed at around four to six weeks with imaging. Beyond roughly that window, continued obstruction risks permanent loss of function in that kidney and the balance shifts towards treating the stone. Waiting is a monitored plan with a review date rather than an open-ended hope.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Does the pain stopping mean the stone has passed?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"Not necessarily, and this is the most dangerous assumption in the subject. A completely obstructed kidney often stops hurting once pressure stabilises, so relief of pain proves nothing. If no stone was seen to pass, follow-up imaging still needs doing, because a silently obstructed kidney can be lost over months without symptoms. Straining the urine and keeping any stone provides both proof and material for analysis.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"When should a trial of waiting be abandoned?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"Immediately for fever or chills, pain that cannot be controlled or keeps returning, vomiting preventing fluid intake, or falling urine output. Also when follow-up shows the stone has not moved, the kidney remains obstructed, or renal function is deteriorating. The alternatives are shockwave lithotripsy or ureteroscopy.\"\n          }\n        }\n      ]\n    }\n  ]\n}\n<\/script>\n","protected":false},"excerpt":{"rendered":"<p>Most small ureteric stones pass by themselves, and a tablet is often added to help them along. Dr. Soarawee Weerasopone explains what the large trials actually showed about that tablet, the side effect men are rarely warned about, and \u2014 the part usually missing \u2014 how long it is safe to keep waiting.<\/p>","protected":false},"author":185281453,"featured_media":10098,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"Medical expulsive therapy for ureteric stones \u2014 what the large randomised trials really showed, which stones benefit, the alpha blocker side effects including ejaculation and cataract surgery, and how long waiting is safe.","jetpack_seo_html_title":"Does Medication Help a Ureteric Stone Pass? | Dr. Pom","jetpack_seo_noindex":false,"jetpack_seo_schema_type":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_wpcom_ai_launchpad_first_post":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"{title}\n\n{excerpt}\n\n{url}","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"_wpas_customize_per_network":false,"jetpack_post_was_ever_published":false},"categories":[1],"tags":[1384,1556,1555],"class_list":["post-4227","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-kidney-stone","tag-kidney-stone","tag-medical-expulsive-therapy","tag-ureteric-stone-pain"],"jetpack_publicize_connections":[],"jetpack_likes_enabled":false,"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/pgZdrK-16b","jetpack_featured_media_url":"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/Stone-Expulsive-Therapy.jpg?fit=1200%2C630&ssl=1","_links":{"self":[{"href":"https:\/\/drsoaraweeurology.com\/ar\/wp-json\/wp\/v2\/posts\/4227","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoaraweeurology.com\/ar\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoaraweeurology.com\/ar\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/ar\/wp-json\/wp\/v2\/users\/185281453"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/ar\/wp-json\/wp\/v2\/comments?post=4227"}],"version-history":[{"count":15,"href":"https:\/\/drsoaraweeurology.com\/ar\/wp-json\/wp\/v2\/posts\/4227\/revisions"}],"predecessor-version":[{"id":11612,"href":"https:\/\/drsoaraweeurology.com\/ar\/wp-json\/wp\/v2\/posts\/4227\/revisions\/11612"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/ar\/wp-json\/wp\/v2\/media\/10098"}],"wp:attachment":[{"href":"https:\/\/drsoaraweeurology.com\/ar\/wp-json\/wp\/v2\/media?parent=4227"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/ar\/wp-json\/wp\/v2\/categories?post=4227"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/ar\/wp-json\/wp\/v2\/tags?post=4227"}],"curies":[{"name":"\u0648\u0648\u0631\u062f\u0628\u0631\u064a\u0633","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}