Diuresis and inversion therapy to improve clearance of lower caliceal stones after shock wave lithotripsy: A prospective, randomized, controlled, clinical study

Abstract

Objective:To improve the clearance of lower caliceal stones (LCSs) after shock wave lithotripsy (SWL) using a combination of intra-operative forced diuresis and inversion therapy.Materials and Methods:One hundred and fifty-seven consecutive patients with symptomatic, single LCSs of 5–20 mm size were prospectively randomized into two groups. The first (study group, SG) underwent SWL at the time of the maximum diuresis with the patient in the Trendelenburg position with an angle of 30 degree, while the second group (control group, CG) underwent standard SWL. After the last SWL session, patients were followed-up regularly using plain abdominal X-ray and renal ultrasound. The primary endpoint of the study was the stone-free rate (SFR) at 12 weeks.Results:A total of 141 patients completed the study treatment protocol and follow-up: 69 patients in SG and 72 patients in CG. Both groups were comparable in baseline data. SG showed significantly higher SFR at all follow-up time points. At week 12, 78.3% of SG were rendered stone free, whereas only 61.1% were stone free in CG (P = 0.030). Also, there was a significantly higher SFR for larger stones (>10 mm) and stones with higher attenuation value (>500 Hounsfield units) in SG than CG. Mild non-significant complications were reported in both groups.Conclusion:SWL with intraoperative forced diuresis and inversion seems to be an effective measure with minimal extra cost to improve LCS clearance post-SWL.

Furosemide improves the stone clearance rate of extracorporeal shockwave lithotripsy for kidney stones but not ureteral stones: a systematic review and meta-analysis

“… 13 Thus, we evaluated the complications in the remaining five studies. 9 – 12 , 14 No complications were observed in the Azm and Higazy 9 and Zomorrodi et al. 10 studies, whereas the remaining three studies reported complications after SWL treatment to remove RS.…”

“…Finally, we included six RCTs that examined the synergistic action of SWL and furosemide against the actions of SWL alone. 9 – 14 A flowchart of our inclusion/exclusion process is presented in Figure 1 , and the demographics of the six eligible articles are summarized in Table 1 .…”

“…Three studies were used for RS fragmentation analysis, since they provided corresponding data. 11 – 13 Due to the presence of insignificant heterogeneity, we employed the fixed-effect model ( p = 0.86; I 2 = 0%). Based on our analysis, an insignificant improvement was observed in RS fragmentation after furosemide + SWL administration (RR = 1.05, 95% CI = 0.94–1.16; p = 0.42), compared to controls.…”

Faculty Opinions recommendation of The efficacy and safety of diuretics on extracorporeal shockwave lithotripsy treatment of urolithiasis: A systematic review and meta analysis.

“…Based on the inclusion and exclusion criteria, 6 RCTs [10][11][12][13][14][15] involving 1344 patients were included in the analysis. Table 1 shows the characteristics of the individual RCTs.…”

A comparison of stone free rate between a diuretic and a control group of patients undergoing extracorporeal shock wave lithotripsy: a prospective, randomized, double-blind, placebo-controlled trial

“…Auxiliary treatment post ESWL Ahmed et al17 defined stone free as no visible stone or residual fragment < 4 mm on x-ray film KUB or ultrasound, and Elkholy et al…”