Medical Management of Stone Disease

Medical management of urinary stone disease involves both treatment directed at resolving an acute episode of symptomatic urolithiasis and prevention of future stone recurrence. Impressive progress has been made recently with regards to medical management of stone disease. In particular, therapies directed at decreasing the ureteral muscle spasm associated with ureteral stone impaction are being increasingly used as medical expulsive therapy for ureteral calculi. In addition, prophylactic medical therapy can significantly reduce the incidence of new stone disease. The recommendations for medical expulsive therapy are strong and based upon moderate to high quality evidence. The recommendations for preventive medical therapy vary by treatment agent and are based upon low to moderate quality evidence. This chapter reviews the current evidence supporting the use of both medical expulsive therapy and preventive medical therapy.