Urolithiasis, also called as urinary stones, is commonest condition approximately in 1 out of 10 individuals with increasing incidence and prevalence worldwide. Theories to explain Ureteric calculus are incomplete and may requires supersaturated urine, pH of urine, ionic strength, solute concentrations, complexation [1]. It is regarded as the third most prevalent urological condition and a common cause of morbidity [2, 3].

A stone in ureter usually comes from kidney above and often causes intermittent attacks of ureteric colic – waves of agonizing pain are typically referred to the groin, external genitalia, hematuria is a typical presentation of ureteric obstruction, most commonly due to calculi [4]. The size, location, composition, and symptoms of the stone all influence the management and therapy options for urolithiasis. Patients who have blocked, infected kidneys need a nephrostomy or stent placed immediately, while people who are afebrile, have a normal contralateral kidney, and have normal renal function are typically treated conservatively [5].

Since the mechanism of stone formation is a complex process resulting from several physicochemical events, such as supersaturation, nucleation, growth, aggregation, and retention of urinary stone constituents within tubular cells, it is shown that the best clinical evidence for homeopathy available till date allow positive evidence for its use in day to day clinical practice. An imbalance between the variables that encourage or prevent urine crystallization affects these stages. The pathophysiology of urolithiasis encompasses both the internal and external constitution and is not limited to the urinary tract alone. Since urolithiasis has multiple causes, a comprehensive approach is necessary for the efficient management of ureteric calculi [6].

The adult human ureter is a muscular tube that is physically separated into three sections: the proximal, middle, and distal ureter. It is primarily made up of smooth muscle cells and is bordered by the urothelium, a multilayered transitional epithelium. Smooth muscle cells are divided into two layers: the outer circular layer coats the ureteral walls and contracts to provide intraluminal pressure, while the inner longitudinal layer is responsible for ureteral shortening and urine movement. Urine is moved from the kidneys to the bladder by waves of smooth muscle contraction and relaxation traveling down the muscular tube, which is the main purpose of this organ. The interstitial cells of Cajal (ICC)-like cells, which are located in the renal pelvis and proximal sections of the human ureter, are the renal pacemaker cells that control this process. The absence of Back 5 ICC-like cells in the ureter's distal areas indicates that ureteral peristalsis begins at the renal pelvis, with the ureter's proximal part thereafter myogenically conducting down the ureteral tube. 

Functional tests conducted on isolated ureters from pigs and humans in vitro indicate that contraction is the primary response to noradrenaline, suggesting that α-adrenoceptors function more prominently than β adrenoceptors [5, 6]. There are three primary subtypes of α-adrenoceptors: α1A,1B,1D. G-proteins belonging to the G family primarily couple the subtypes of α-adrenoceptors to trigger the phospholipase C mechanism, hence inducing contraction of smooth muscle [7].

Calcium channel blockers are frequently used to decrease smooth muscle contractions in illnesses including hypertension, angina, and arrhythmias since smooth muscle contraction in most tissues traditionally occurs via an increase in intracellular calcium. Thus, in isolated ureteral tissues from humans and pigs, calcium channel blockers such as nifedipine, verapamil, and diltiazem suppress spontaneous rhythmic activity and inhibit ureteral contractile activity induced by electrical stimulation, potassium, and phenylephrine [8]. Although nifedipine is effective in raising expulsion rate, most studies that have examined the usefulness of nifedipine alone as a therapy have found that it is significantly less effective than tamsulosin [9, 10]. In addition, compared to participants receiving a placebo or tamsulosin, nifedipine was linked to a greater frequency of side effects, such as headaches, nausea, and drowsiness [9]. 

It is commonly known that cyclooxygenase (COX) enzymes are necessary for the formation of prostaglandins (PG) because they convert arachidonic acid to an intermediate PGH, which is subsequently metabolized to PGD, PGE, PGF, and PGI. The COX enzyme has two isoforms: COX-1, which is expressed constitutively in many tissues, and COX-2, which is inducible and can be triggered by a variety of stimuli, such as nerve stimulation, mucosal injuries, and inflammatory mediators [11].

Earlier clinical trials examining the effects of non-steroidal anti-inflammatory medicines (NSAIDs) showed that NSAIDs can relieve colic in patients with urolithiasis given prostaglandins' apparent function in raising pain sensitivity [12]. The two NSAIDs that are most frequently used for ureteral colic are celecoxib and diclofenac ,in order to minimize many of the side effects the majority of trials have only included short-term NSAID prescriptions usually in conjunction with either α-adrenoceptor antagonists or calcium channel blockers have known to be a useful treatment [13-15]. 

European and US(EAU/AAU) guidelines recommend, MET as an option when following conditions are met, with close follow-up which is clinically effective, as 88% of the patients did not require surgery for their stone [16].

Relevant articles and literature were searched using electronic databases. Following terms like (medical expulsive therapy or ureteral/ureteric stone) are used in search process.

The article selection was conducted according to the search strategy. The search and selection criteria were limited to inclusion and exclusion criteria mentioned. Studies that did not satisfy the mentioned criteria will be excluded.

Cochrane library, Medline, Embase, Elsevier.

A Preliminary selection of studies after database searching process was performed independently by two researches, through title and abstract analysis, in order to verify the adherence to reviews topic and research topics. Identifying the primary papers [n=2679], excluding the studies based on titles[n=1009], excluding the studies based on full texts [n=590], excluding based on eligibility criteria [n=53], excluding based on dates [n=8]

First search: At the beginning articles were obtained using the search engines from individual databases using the main terminology in broader aspects. Specific key words were further applied step wise to the obtained articles which brought down the number to 53 after which eligibility criteria narrowed it to 8.

Second search: from the references of primary papers, many were screened but got removed after eligibility criteria assessment. so, none was added. Extracting data from final set of 10 papers with data analysis was done which showed the following information.

The results of literature search are tabulated as follows:

Making patient centered care as central idea for medical management, CAM can be given a chance in this particular field of urology to minimize the chances of surgery and increase the chances of conservative management unless associated with complications. Many Research articles are found to focus on the central idea of integrative medicine, differentiated by its patient- centered, holistic approach and its seamless integration of conventional and complementary therapies. Homeopathy involves the administration of personalized remedies that are specifically suited to address particular symptoms [17].  

The results of invitro studies mentioned so far clearly indicates a strong anti urolithiatic properties of various homoeopathic remedies but clinical trials in this particular field are less, even if then control group must be included which is not seen. Flaws in research methodology must be properly addressed for clinical trials. The main key findings of this conceptual literature review are that the proof for efficacy of Homoeopathy as MET for management of ureteric calculi is evidenced by literary as well as empirical research data regardless proper study design, steps to minimize bias, with objective evidence, more clinical trials should be done to add more strength to currently existing ones.

This literature review analysed evidence about efficacy of Homoeopathy as medical expulsive therapy (MET) in the management of ureteric calculi. Literature available and researches also support this statement as it can provide the cost effective as well as conservative management in uncomplicated cases of ureteric calculi. 

Despite the methodological quality of the included studies, this review summarizes potentially useful information to provide to patients suffering from ureteric calculi with the aim of supporting them with further conduction of high-quality studies. Further homogeneous studies, in design method and outcomes measurement, and with high methodological quality, are needed to better clarify whether there is additional benefit from other treatment modalities like Homoeopathy. Meanwhile, following the guidelines of conservative management of ureteric calculi can yield good results thus providing recommendations and interesting suggestions for future research.