Adjunctive medical expulsive therapy with tamsulosin for repeated extracorporeal shock wave lithotripsy: a systematic review and meta-analysis

ABSTRACT Purpose: To evaluate the efficacy of adjunctive medical expulsive therapy (MET) with tamsulosin for the promotion of stone fragments clearance for repeated extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: This meta-analysis was conducted by systematic search for randomized controlled trial (RCT) studies in PubMed/Medline, Scopus, Cochrane Library, Web of Science databases in January 2020, which compared tamsulosin with either placebo or non-placebo control for repeated ESWL. The primary endpoint was stone-free rate (SFR), the second endpoints were stone clearance time and complications. The quality assessment of included studies was performed by using the Cochrane System and Jadad score. Results: 7 RCTs were included in this meta-analysis. Tamsulosin provided higher SFR (for stones larger than 1cm, OR: 5.56, p=0.0003), except for patients with stones less than 1cm. For patients with renal stones (OR: 2.97, p=0.0005) or upper ureteral stones (OR: 3.10, p=0.004), tamsulosin can also provide a higher SFR. In addition, tamsulosin provided a shorter stone clearance time (WMD: −9.40, p=0.03) and lower pain intensity (WMD=-17.01, p <0.0001) and incidences of steinstrasse (OR: 0.37, p=0.0002). Conclusion: Adjunctive MET with tamsulosin is effective in patients with specific stone size or location that received repeated ESWL. However, no well-designed RCT that used computed tomography for the detection and assessment of residual stone fragments was found. More studies with high quality and the comparison between tamsulosin and secondary ESWL are needed in the future.

Current scenario of endourological treatment of kidney stones in brazil: results of a national survey

ABSTRACT Objective: To elucidate the current scenario of endourology in Brazil for the treatment of urinary lithiasis, with an emphasis on regional differences and the reasons why certain techniques are still underutilized. Materials and Methods: An electronic questionnaire was sent by email to the 4,745 members of the Brazilian Urological Society (BSU) in 2016 to collect information on the 3 main endourological procedures used in the treatment of nephrolithiasis: Semi-rigid ureteroscopy (URS), Flexible ureteroscopy (F-URS) and percutaneous nephrolithotripsy (PCNL). Results: A total of 1,267 urologists answered the questionnaire. It was observed that the vast majority perform URS (95.6%), while 80.2% perform F-URS and only 72.1% perform PCNL. Regarding the surgical volume, most perform up to 10 procedures per month (73.4% to 88.2%) and the main impediment was the lack of patients with the pathology (42.1% to 67.7%). The lack of equipment or hospital infrastructure was one of the main limiting factors for rigid (23%) and flexible (38.1%) URS, mainly in the North and Northeast regions of the country. Regarding PCNL, most of them reported lack of practical experience in the method (29.9%). Finally, most urologists expressed interest in taking courses in endourology. Conclusion: Ureteroscopy, rigid or flexible, is already well established in the country, requiring the direction of more resources for its practice, especially in less developed regions. Regarding PCNL a significant part of Brazilian urologists still lack practical experience in this procedure, emphasizing the need for greater investment in teaching this technique.

Flexible ureterorenoscopy is associated with less stone recurrence rates over Shockwave lithotripsy in the management of 10-20 millimeter lower pole renal stone: medium follow-up results

ABSTRACT Purpose To identify the role of shock wave lithotripsy (SWL) and flexible ureterorenoscopy (f-URS) on the stone recurrence, in the management of 10-20 millimeter lower pole stone (LPS) with medium follow-up outcomes. Materials and Methods The patients' charts which were treated with SWL or f-URS for LPS between January 2011 and September 2013 were analyzed, retrospectively. Patients who had a solitary 10-20mm LPS were enrolled into the study. In both procedures, patient was accepted as stone free, if complete stone clearance was achieved in the 3rd month abdominal computed tomography. Only patients with a stone free status were evaluated in follow ups. Results The stone-free rate was 77.9% (88/113 patients) for the SWL group and 89% (114/128 patients) for the f-URS group (p=0.029). Stone recurrence was detected in 28 (35.4%) patients in SWL group and in 17 (17.2%) patients in f-URS group (p=0.009). Stone types and 24 hour urine sample results were similar between groups (p=0.123 vs p=0.197, respectively). Multivariate regression analysis revealed that f-URS procedure and absence of abnormality in 24 hour urine analysis significantly decreased stone recurrence in medium term follow-up (p=0.001 and p<0.001, respectively). Conclusions Our study showed for the first time, that patients which underwent f-URS for LPS, faced less stone recurrence, independent from diet regimen and metabolic evaluation in medium term follow-up. Additionally, presence of abnormality in 24 hour urine analysis increase the stone recurrence risk in follow-ups.

Can renal stone size and the use of the nephrolithometric system increase the efficacy of predicting the risk of failure of percutaneous nephrolithotripsy? / O tamanho do cálculo renal e o uso do sistema nefrolitométrico podem aumentar a eficácia de predizer o risco de falha de nefrolitotripsia percutânea?

ABSTRACT Objective : to verify the association of success rate of percutaneous lithotripsy, Guy score and size of the stone. Methods: one hundred patients submitted to percutaneous nephrolithotripsy were evaluated. All stones were classified according to Guy Score. Patient free of stone was considered when residual fragments were ≤2mm. Results: according to guy Score, 54% were score 1 (Group 1), 18% score 2 (Group 2), 15% score 3 (Group 3), and 13% score 4 (Group 4). Success was observed in 77.77% in Group 1, 27.77% in group 2, 26.6% in Group 3, and 7.69% in Group 4. In patients with Guy score 1, there was statistical significance of prediction of free stone rate when evaluated according to the size of the stone. Among groups 2, 3 and 4 there was no statistical significance, but it was observed a trend in relation to stone size, the bigger the higher the chance of residual fragments. Conclusion: nephrolithometry by Guy Score and size of the stone are single predictors of success of percutaneous nephrolithotripsy. Stone size may influence success rate of patients with Guy Score 1.

RESUMO Objetivo: verificar a associação entre taxa de sucesso de nefrolitotripsia percutânea, escore de Guy e tamanho do cálculo. Métodos: foram avaliados 100 pacientes submetidos à nefrolitotripsia percutânea. Todos os cálculos foram classificados de acordo com o escore de Guy. Consideramos o paciente livre de cálculos quando os fragmentos residuais fossem menores ou iguais a 2mm. Resultados: de acordo com o escore de Guy, 54% tinham escore 1 (Grupo 1), 18% escore 2 (Grupo 2), 15% escore 3 (Grupo 3) e 13% escore 4 (Grupo 4) . Houve resolução de 77,77% no grupo 1, de 27,77% no grupo 2, de 26,6% no grupo 3 e de 7,69% no grupo 4. Houve significância estatística para predição de taxa livre de cálculos entre os pacientes com escore de Guy 1 quando avaliados de acordo com o tamanho do cálculo. Entre os grupos 2, 3 e 4 não houve significância estatística, porém observamos tendência de que quanto maior o tamanho do cálculo, maior a chance de cálculo residual. Conclusão: a nefrolitometria pelo Escore de Guy e o tamanho do cálculo são preditores isolados para avaliação de sucesso da nefrolitotripsia percutânea. O tamanho do cálculo pode influenciar a taxa de sucesso de pacientes com Escore de Guy 1.

A neural network - based algorithm for predicting stone -free status after ESWL therapy

ABSTRACT Objective: The prototype artificial neural network (ANN) model was developed using data from patients with renal stone, in order to predict stone-free status and to help in planning treatment with Extracorporeal Shock Wave Lithotripsy (ESWL) for kidney stones. Materials and Methods: Data were collected from the 203 patients including gender, single or multiple nature of the stone, location of the stone, infundibulopelvic angle primary or secondary nature of the stone, status of hydronephrosis, stone size after ESWL, age, size, skin to stone distance, stone density and creatinine, for eleven variables. Regression analysis and the ANN method were applied to predict treatment success using the same series of data. Results: Subsequently, patients were divided into three groups by neural network software, in order to implement the ANN: training group (n=139), validation group (n=32), and the test group (n=32). ANN analysis demonstrated that the prediction accuracy of the stone-free rate was 99.25% in the training group, 85.48% in the validation group, and 88.70% in the test group. Conclusions: Successful results were obtained to predict the stone-free rate, with the help of the ANN model designed by using a series of data collected from real patients in whom ESWL was implemented to help in planning treatment for kidney stones.

Effect of aqueous extract of [eryngium campestre] on the prevention of pathologic alterations caused by calcium oxalate crystals induced by ethylene glycol in the cortex and medulla of rats' kidneys

Background and Aim: Due to the effects of herbs in the prevention of kidney stones, the present study aimed at assessing the effect of aqueous eryngium campestre on the prevention of pathologic alterations caused by calcium oxalate crystals induced by ethylene glycol in the cortex and medulla of rats'kidneys

Materials and Methods: To conduct the study 40 male Wistar rats, weighing 200 - 250 gr were randomly divided into 5 equal groups; i.e. the healthy control group that just received water, the negative control group receiving water with 1% ethylene glycol, the prevention groups, which in addition to 1% ethylene glycol in water were daily gavaged with 100 mg/kg, 200mg/kg, and 400 mg/kg of the plant extract. After 30 days all rats were killed and slides from each one's kidneys were prepared. The slides were stained applying H/E method and the number of their calcium oxalate crystals was checked

Results: It was found that there was a significant difference between the number of their calcium oxalate crystals in the control health and negative groups [P<0.05]. But, in the prevention group gavaged 100 mg/kg there was no significant difference with the negative group, [P>0.05]. However, in the 200mg/kg prevention group compared to the negative control one there was a significant difference in reducing the number of the crystals [P<0.05]. But in 400mg/kg the prevention group there was no significant difference with the negative control group [P>0.05]

Conclusion: It was discovered that aqueous extract of eryngium campestre is effective in preventing the accumulation of calcium oxalate crystals in the kidney

Is There A Difference Between Presence of Single Stone And Multiple Stones in Flexible Ureterorenoscopy And Laser Lithotripsy For Renal Stone Burden < 300mm2 ?

ABSTRACT In this study, we aim to evaluate and compare the effectiveness of flexible ureterorenoscopy (f-URS) for solitary and multiple renal stones with <300 mm2 stone burden. Patients' charts who treated with f-URS for kidney stone between January 2010 and June 2015 were reviewed, retrospectively. Patients with solitary kidney stones (n:111) were enrolled in group 1. We selected 111 patients with multiple kidney stones to serve as the control group and the patients were matched at a 1:1 ratio with respect to the patient's age, gender, body mass index and stone burden. Additionally, patients with multiple stones were divided into two groups according to the presence or abscence of lower pole stones. Stone free status was accepted as complete stone clearence and presence of residual fragments < 2 mm. According to the study design; age, stone burden, body mass index were comparable between groups. The mean operation time was longer in group 2 (p= 0.229). However, the mean fluoroscopy screening time in group 1 and in group 2 was 2.1±1.7 and 2.6±1.5 min, respectively and significantly longer in patients with multiple renal stones (P=0.043). The stone-free status was significantly higher in patients with solitary renal stones after a single session procedure (p=0.02). After third month follow up, overall success rate was 92.7% in Group 1 and 86.4% in Group 2. Our study revealed that F-URS achieved better stone free status in solitary renal stones <300 mm2. However, outcomes of F-URS were acceptable in patients with multiple stones.

Complete supine PCNL: ultrasound vs. fluoroscopic guided: a randomized clinical trial

ABSTRACT Introduction and Hypothesis: To compare complications and outcomes of complete supine percutaneous nephrolithotomy (csPCNL) with ultrasound guided and fluoroscopically guided procedure. Materials and Methods: In this randomized clinical trial study from January 2009 to September 2010, 26 of 51 patients with renal stones underwent csPCNL with ultrasonographic guidance in all steps of the procedure (group A), and the other 25 patients underwent standard fluoroscopically guided csPCNL (group B). All of the patients underwent PCNL in the complete supine position. Statistical analysis was performed with SPSS16 software. Results: Mean BMI was 28.14 in group A and 26.31 in group B (p=0.30). The mean stone burden was 26.48 and 30.44 in groups A and B, respectively (p=0.20). The stone free rate was 88.5% in group A and 75.5% in group B, that was no significant (p=0.16). Overall 2 patients (7.7%) in group A and 6 patients (24%) in group B had complications (p=0.11). Mean operative time in group A was 88.46 minutes, and in group B it was 79.58 minutes (p=0.39). Mean hospital stay was 69.70 and 61.79 hours in group A and B, respectively (p=0.22). There was no visceral injury in groups. Conclusions: This randomized study showed that totally ultrasonic had the same outcomes of fluoroscopically csPCNL. Ultrasonography can be an alternative rather than fluoroscopy in PCNL. We believe that more randomized studies are needed to allow endourologists to use sonography rather than fluoroscopy in order to avoid exposition to radiation.

Tratamento da nefrolitíase: onde está a evidência dos ensaios clínicos? / Therapy of nephrolithiasis: where is the evidence from clinical trials?

Resumo A prevalência da nefrolitíase está aumentando em todo o mundo e resulta em ônus significativo para o sistema de saúde. Novos estudos revelam que a formação de cálculos urinários está associada a várias morbidades graves. No entanto, poucos estudos observacionais ou ensaios clínicos randomizados de qualidade demonstraram que intervenções clínicas específicas diminuem a recorrência da nefrolitíase. Portanto, nesta revisão são analisadas as evidências disponíveis da terapia médica expulsiva para cálculos ureterais; avaliam-se os dados da terapêutica não farmacológica, incluindo modificações dietéticas e terapia à base de sucos cítricos; e discute-se a eficácia dos diuréticos tiazídicos no tratamento da hipercalciúria associada à nefrolitíase recorrente.

Abstract The prevalence of kidney stone disease is increasing worldwide with significant health and economic burden. Newer research is finding that stones are associated with several serious morbidities. Yet, few randomized clinical trials or high quality observational studies have assessed whether clinical interventions decrease the recurrence of kidney stones. Therefore, in this review we analyze the available evidence on medical expulsive therapy for ureteral stones; describe the evidence about non-pharmacological stone therapy including dietary modifications and citrus juice-based therapy; and discuss the efficacy of thiazide diuretics for the treatment of hypercalciuria in recurrent nephrolithiasis.

Impact of retrograde flexible ureteroscopy and intracorporeal lithotripsy on kidney functional outcomes

ABSTRACT Objective: The aim of the study was to evaluate renal function and to identify factors associated with renal function deterioration after retrograde intrarenal surgery (RIRS) for kidney stones. Materials and Methods: We retrospectively analyzed patients with renal stones treated by RIRS between January 2010 and June 2013 at a single institute. We used the National Kidney Foundation classification of chronic kidney disease (CKD) to classify Glomerular Filtration Rate (GFR) in 5 groups. The baseline creatinine level was systematically pre-operatively and post-operatively evaluated. All patients had a creatinine blood measurement in June 2013. A change toward a less or a more favorable GFR group following RIRS was considered significant. Results: We included 163 patients. There were 86 males (52.8%) and 77 females (47.3%) with a mean age of 52.8±17 years. After a mean follow-up of 15.5±11.5 months, median GFR was not significantly changed from 84.3±26.2 to 84.9±24.5 mL/min (p=0.675). Significant renal function deterioration occurred in 8 cases (4.9%) and significant renal function amelioration occurred in 23 cases (14.1%). In univariate analysis, multiple procedures (p=0.023; HR: 5.4) and preoperative CKD (p=0.011; HR: 6.8) were associated with decreased renal function. In multivariate analysis these factors did not remain as predictive factors. Conclusion: Stone management with RIRS seems to have favorable outcomes on kidney function; however, special attention should be given to patients with multiple procedures and preoperative chronic kidney disease.

Value of CT angiography in reducing the risk of hemorrhage associated with mini-percutaneous nephrolithotomy

ABSTRACTPurpose:To evaluate the clinical value of computed tomography angiography (CTA) in reducing the risk of hemorrhage associated with mini-percutaneous nephrolithotomy (PCNL).Materials and Methods:A total of 158 patients with renal or ureter stones who had undergone mini-percutaneous nephrolithotomy were retrospectively enrolled into this study from May of 2011 to April of 2014. Group 1 (65 patients) underwent computed tomography angiography, and Group 2 (93 patients) underwent non-contrast CT. The clinical characteristics of the patients and hemorrhagic complications were recorded. The hematologic complications (transfusion rate, and preoperative and postoperative hemoglobin values) were assessed.Results:There were no statistically significant differences in age, body mass index(BMI), stone diameter, operative time, stone-free rate, and hospital stay between the 2 groups. In group 2, 1 patient (1.1%) developed a renal arteriovenous fistula and was treated with embolus therapy. In addition, Group 2 showed significantly drop in hemoglobin (3.6 g/dL vs. 2.4 g/dL, respectively; P <0.001) and more transfusions (9.7% vs. 1.5%, respectively; P <0.05) compared with Group 1.Conclusion:The study showed that patients who underwent computed tomography angiography prior to percutaneous nephrolithotomy had lower drop of hemoglobin and needed less transfusions. These findings may suggest that the use of computed tomography angiography may reduce the risk of bleeding during percutaneous nephrolithotomy.

Flexible Ureteroscopic Management of Horseshoe Kidney Renal Calculi

ABSTRACTPurpose:To evaluate the clinical efficacy of flexible ureteroscope (F-URS) combined with holmium laser lithotripter in treating renal calculi in horseshoe kidney.Materials and Methods:From November 2010 to December 2013, the medical history and charts of sixteen patients (mean age 42.9±11.6 years, range 26-66 years), including 13 males and 3 females were analyzed retrospectively. Mean stone burden was 29±8 mm (range 17-42 mm2). Mean stone digitized surface area (DSA) was 321±94 mm2 (range 180-538 mm2). Under spinal anesthesia in a modified lithotomy position with the head down, rigid ureteroscope was placed firstly into the ureter to reach the level of the pelvis, a zebra guide wire was inserted and following the removal of the rigid ureteroscope, an ureteral access sheath was positioned along the guide wire, then passed the URF P-5 flexible ureteroscope into the renal cavities over the guidewire. After locating the stones, holmium laser lithotripsy was performed.Results:The average operative time was 92±16 minutes (range 74-127 min.). No major complications were encountered. Ten patients obtained stone-free status with one session, four obtained stone-free status after two sessions. Single session stone-free rate was 62.5%, overall stone-free rate was 87.5%. Two patients have small residual stones in the lower pole.Conclusions:F-URS combined with holmium laser lithotripter and nitinol basket, is safe and effective in dealing with moderate stone diameter (<30 mm) in HSKs with high clearance rates and low complication rates.

Is quantitative diffusion-weighted MRI a valuable technique for the detection of changes in kidneys after extracorporeal shock wave lithotripsy?

Objective The aim of this study was to evaluate the capability and the reliability of diffusion-weighted imaging (DWI) in the changes of kidneys occurring after extracorporeal shock wave lithotripsy (ESWL) treatment for renal stones. Materials and Methods A total of 32 patients who underwent ESWL treatment for renal stone disease between June and December 2011 were enrolled in this prospective study. Color Doppler ultrasonography (CDUS) and DWI were performed before and within 24 hours after ESWL. DWI was obtained with b factors of 0, 500 and 1000 s/mm2 at 1.5 T MRI. Each of Resistive index (RI) and ADC values were calculated from the three regions of renal upper, middle and lower zones for both of the affected and contralateral kidneys. Paired sample t test was used for statistical analyses. Results After ESWL, the treated kidneys had statistically significant lower ADC values in all different regions compared with previous renal images. The best discriminative parameter was signal intensity with a b value of 1000 s/mm2. The changes of DWI after ESWL were noteworthy in the middle of the treated kidney (p<0.01). There were no significant difference between RI values in all regions of treated and contralateral kidneys before and after treatment with ESWL (p>0.05). Conclusion DWI is a valuable technique enables the detection of changes in DWI after ESWL treatment that may provide useful information in prediction of renal damage by shock waves, even CDUS is normal. .

The effect of renal cortical thickness on the treatment outcomes of kidney stones treated with shockwave lithotripsy

PURPOSE: Because the shock wave passes through various body tissues before reaching the stone, stone composition may affect the treatment efficacy of shock wave lithotripsy (SWL). We investigated the effect of various tissue components along the shock wave path on the success of SWL. MATERIALS AND METHODS: From October 2008 to August 2010, a total of 206 patients with kidney stones sized 5 to 20 mm were prospectively recruited for a study of the factors that affect the outcome of treatment with a Sonolith Vision lithotripter. Successful SWL was defined as either stone-free status or residual fragments <4 mm at 12 weeks. Logistic regression analysis was performed to assess the factors that predicted treatment outcomes. Potential predictors included the patient's age, shock wave delivery rate, stone volume (SV), mean stone density (MSD), skin-to-stone distance (SSD), and the mean thickness of the three main components along the shock wave path: renal cortical thickness (KT), muscle thickness (MT), and soft-tissue thickness (ST). RESULTS: The mean age of the patients was 53.8 years (range, 25-82 years). The overall treatment success rate after one session of SWL was 43.2%. The mean KT, MT, and ST were 26.9, 16.6, and 40.8 mm, respectively. The logistic regression results showed that a slower shock wave delivery rate, smaller SV, a lower MSD, and a thicker KT were found to be significant predictors for successful SWL. SSD, MT, and ST were not predictors of successful treatment. CONCLUSIONS: Among the main tissue components along the shock wave path, a thicker KT was a favorable factor for successful SWL after adjustment for SV, MSD, and the shock wave delivery rate.

Extra corporeal shockwave lithotripsy resulting in skin burns – a report of two cases

Severe skin injury after extracorporeal shock wave lithotripsy (ESWL) is rare. We describe two patients who suffered full thickness skin burns following ESWL for renal calculi. One patient was treated conservatively and the other underwent debridement with skin grafting. We speculate that failure of the thermostatic mechanism of the lithotripter, leading to overheating of the water-filled cushion, resulted in this very rare adverse event. Proper preoperative patient counseling regarding the risk of serious burn injuries will help to avoid potential litigation.

Comparison of Pneumatic, Ultrasonic and Combination Lithotripters in Percutaneous Nephrolithotripsy

Purpose We aimed to compare the outcomes of pneumatic (PL), ultrasonic (UL) and combined (PL/UL) lithotripsy performed in percutaneous lithotripsy (PNL) according to success rates and stone clearence. Materials and Methods The medical records of 512 patients treated with PNL between April 2010 and April 2013 were evaluated. Postoperative stone analysis revealed as calcium oxalate in 408 of these patients. The operation notes of 355 patients recorded in detail with complete parameters were reviewed. According to stone disintegration method, patients were divided into three groups: PL only in Group I, UL only in Group II, and UL/PL combination in Group III. Number of patients was 155, 110 and 90, respectively. Results Fluoroscopy screening time was significantly shorter in group II, and III compared to group I (p<0.001). The failure rates were 13.5% (21 patients) for group I, 3.6% (4 patients) for group II, and 3.3% (3 patients) for group III. There was a significant statistical difference in favor of group II and III by means of success (p=0.023). Group II and III had larger FSA, and this was statistically significant (p=0.032). Stone disintegration time (SDT) was 64.0±41.92 minutes for group I, 49.5±34.63 for group II, and 37.7±16.89 for group III. Group III has a statistically significant shorter SDT (p=0.011). Conclusions We concluded that, in cases with high stone burden, where faster and efficient lithotripsy is needed, combined ultrasonic / pneumatic lithotripter may be the ideal choice and in suitable cases ultrasonic lithotripter usage provides important advantages to the surgeon. .

The efficacy of radiographic anatomical measurement methods in predicting success after extracorporeal shockwave lithotripsy for lower pole kidney stones

Objectives To assess the impact of lower pole calyceal anatomy on clearace of lower pole stones after extracorporeal shockwave lithotripsy (ESWL) by means of a new and previously defined radiographic measurement method. Materials and Methods Sixty-four patients with solitary radiopaque lower pole kidney stones were enrolled in the study. Infundibulopelvic angle (IPA), infundibulotransverse angle (ITA), infundibular lenght(IL), and infundibular width (IW) were measured on the intravenous urographies which were taken before the procedure. Results 48 of 64 patients (75%) were stone-free after a follow-up period of 3 months. The IPA,ITA,IL and IW were determined as statistically significant factors, while age,gender and stone area were found to have no impact on clearance. Conclusion By the help of radiographic measurement methods related to lower pole kidney anatomy, appropriate patient selection and increment in success after ESWL may be achieved. .