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

Abstract

Objectives: To compare the stone free rate and treatment success rate between a diuretic group of patients undergoing extracorporeal shock wave lithotripsy (ESWL) and a control placebo group (normal saline solution). Materials and Methods: One hundred and ninety-four patients with solitary renal calculi or ureteric calculi size of 5 mm or over were prospectively randomized into 2 groups. Ninety-seven patients in the first group (diuretic group) underwent ESWL after intravenous injection of furosemide 40 mg, and 97 patients in the second (control) group received normal saline solution 4 ml instead of furosemide prior to ESWL. The treatment protocol included 3,000 shockwaves per patient in each session with the energy beginning at 8 and progressing up to 15 kilovolts. A maximum of 3 ESWL sessions were permitted per patient. The primary outcome was stone free rate, and the secondary outcome was treatment success rate at 3 months after the first ESWL treatment. Results: The stone free rate was 48.5% compared to 50.5% for diuretic group and control group respectively and the treatment success rate was 81.4% compared to 64.9%. The difference in stone free rate was not statistically significantly different (p = 0.87), however the treatment success was, p = 0.01. Conclusion: A combination of diuretic therapy followed by ESWL improves the treatment success rate compared with standard ESWL therapy alone.

Treatment outcomes and factors affecting the success of extracorporeal shockwave lithotripsy in urinary stone treatment: a study of ten years of data from Mahasarakham Hospital

“…6,7 Previous studies had demonstrated that predicting factors such as stone size, stone location, stone density, severity of obstruction, urinary tract anatomy, obesity, SSD, type of ESWL machine and use of diuretics could have an influence on the success rate of ESWL. [13][14][15][16][17][18][19] Many studies discussed factors affecting outcome of ESWL, but only a few considered age as being a significant factor. One study of 3,023 patients with renal and ureteric calculi treated with ESWL revealed that older patients had a significant poorer stone-free rate.…”

“…One study showed that the success of ESWL treatment was only 47% in the treatment of lower calyceal stones compared to that of 79% for stones in other sites (chi-squared = 6.3, df = 1, p = 0.012). 17 A recent study revealed a stone-free rate of 75% for treatment of lower calyceal stone (size ranging from 10-20 mm) with ESWL. 25 In our study, we found that the stone location was a significant predictor of ESWL outcome in the univariate analysis.…”

“…[6][7][8][9][10][11] The results of ESWL are measured with regard to stone fragmentation and clearance, which have been found to be influenced by some predicting factors such as stone size, stone location, skin-tostone distance (SSD), stone composition, severity of obstruction, urinary tract anatomy, obesity, and ESWL machine type. [12][13][14][15][16][17][18][19][20] ESWL had been one of the mainstays in the management of renal and ureteric calculi since its inception in 1984, and it is currently one of the most recommended treatment options for small-and medium-sized stones. The use of ESWL increased up until 2006 but then started to decline because many urologists switched to endoscopic surgical treatments especially ureteroscopy and laser fragmentation.…”

Pengaruh Diuretik Terhadap Stone-Free Rate Batu Ureter dengan Pneumatic Lithotripsy

“…Penelitian Peerapat pada tindakan ESWL dengan pemberian diuretik menunjukkan tidak ada perbedaan tingkat bebas batu pada kelompok diuretik dan kelompok kontrol (48,5% vs 50,5%, p=0,87). Namun, kejadian complete clearance of stone free (CCSF) dan tingkat keberhasilan pengobatan keseluruhan lebih tinggi secara signifikan pada kelompok diuretik dibanding kelompok kontrol, masing-masing 33% vs 15,5%, p<0,01, dan 81,4% vs 64,9%, p= 0,01 (Cheewaisrakul, 2021).…”