UroToday.com - Over the past decade, the most significant advance, in my mind, with regard to the treatment of the distal ureteral stone, has been the advent of medical expulsive therapy as described by Porpiglia and colleagues in 2000, and corroborated by many subsequent studies. Savings with this approach, according to work by Lotan and colleagues, is around $1100/patient in addition to the benefits of decreased renal colic. Stone passage rates increase anywhere from 40-100% of controls within 10 days of starting medical expulsive therapy. While a variety of medications have been used (e.g. alpha blockers, steroids, calcium channel blockers), the alpha blockers (i.e. tamsulosin and alfuzosin) appear to be effective and well tolerated.