Urolithiasis – medical therapies

Abstract

What ' s known on the subject? and What does the study add? The medical management of urolithiasis is complex. There are many papers written on the topic and many confl icting views. It can be diffi cult for physicians to interpret these data and have a stepwise approach to the medical treatment of stones.Thus this study provides a framework and a review of the literature to allow physicians to practise evidence-based medicine when medically managing urolithiasis. SUMMARYThis review paper provides a summary of medical therapies available for urolithiasis. The summary includes general medical advice, prophylactic medications, dissolution therapy and medical expulsion therapy. The paper is designed to provide a management strategy for all physicians who treat urolithiasis, from general practitioners, to emergency physicians, to urologists. OBJECTIVE• To provide an up to date review of the literature in relation to the medical management of stone disease. This will encompass prophylaxis, dissolution therapy and medical expulsion therapy. PATIENTS AND METHODS• First-time stone formers do not regularly have a full urine and electrolyte evaluation due to the low incidence of a reversible metabolic cause.• However, stone disease is common and over a lifetime urolithiasis can affect up to 10 -15% of the population. RESULTS• Medical management of stone disease encompasses preventative measures, medical dissolution and medical expulsion therapy. CONCLUSIONS• Recurrent stone formers should have dietary optimization to decrease the risk of further stones.• Furthermore, the correct use of prophylactic and therapeutic medications can decrease the morbidity associated with ureteric calculi.

Urolithiasis: An Update on Diagnostic Modalities and Treatment Protocols

“…Being a xanthine oxidase inhibitor it inhibits uric acid production from hypoxanthine and xanthine thus reducing urate levels in urine, which again turns out to be inhibitory for nucleation of calcium oxalate [65][66][67] . Febuxostat is also a xanthine oxidase inhibitor like allopurinol but has been found to be more efficacious in reducing urinary urate levels as compared to allopurinol [21] .…”

“…Potassium citrate also tends to inhibit uric acid stone formation owing to its alkalinizing effect on urine [67][68][69] . Unlike sodium citrate and sodium bicarbonate, it does not tend to raise sodium load, which is known to increase calcium excretion and produce citrate reduction in urine and is therefore preferred over them [66] . But, it does possess tendency for producing gastrointestinal upset [69] .…”

Nephrolithiasis - An updated Review in Relation to Diagnosis, Prevention and Treatment

“…g) Alpha mercaptopropionylglycine (or tiopronin) is a better tolerated alternative to D-penicillamine, but its efficacy and availability is very less as compared to D-penicillamine [36].…”

Protective effect of magnesium lactate gluconate and Garcinia cambogia fruit extract in experimentally induced renal calculi in rats

“…Thiazide diuretics (hydrochlorothiazide) and allopurinol (in patients with idiopathic CaOx stones in hyperuricosuria) are also being used in the management of CaOx stone disease [8]. However, it is also reported that the risk of recurrence is 40% at 5 years and 75% at 20 years after passage of a first stone [9].…”

“…For instance, thiazides decrease urinary calcium excretion but may lead to hypokalemia which in turn cause hypocitraturia and promote stone formation. Similarly, sodium bicarbonate therapy may precipitate CaOx (due to sodium overload) or CaP stone (due to alkaline pH) [8]. This implies that there is a greater need to develop more effective drugs for treating stone disease with fewer or no complications.…”