Efficacy of extracorporeal shockwave lithotripsy with furosemide and hydration in renal stone management: A randomised controlled trial

Abstract

2019) Efficacy of extracorporeal shockwave lithotripsy with furosemide and hydration in renal stone management: A randomised controlled trial, Arab Journal of Urology, 17:4, 279-284, ABSTRACT Objective: To assess the effect of diuretics (furosemide) administered before extracorporeal shockwave lithotripsy (ESWL) followed by continuous infusion of 0.9% NaCl during the ESWL in patients with renal stones. Patients and methods: A tertiary care teaching hospital-based prospective randomised controlled trial was conducted from July 2015 to June 2017, including 714 patients who underwent ESWL. The patients were randomised in two groups: in Group-A, patients received 40 mg furosemide 30 min before each ESWL session and 1000 mL 0.9% NaCl intravenous hydration during the procedure. In Group-B, the patients only received 0.9% NaCl. All patients were followed-up every 2 weeks for 3 months with X-ray and ultrasonography of the kidney, ureter and bladder. Patients without a radio-opaque stone at follow-up were classified as successes. Results: After 2 months, the stone-free rate (SFR) was much higher in Group-A, at 77.0% vs 65.3% (P < 0.001). Further, for patients aged ≤40 years, the SFR was significantly higher in Group-A than Group-B, at 89.2% vs 71.4% (P < 0.001). The mean (SD) age of the patients was 34.4 (8.23) years. Amongst them, 441 (61.8%) were male and 273 (38.2%) were female. The mean (SD) stone size was 1.42 (0.21) cm in Group-A and 1.40 (0.20) cm in Group-B. Conclusion: We conclude that the efficacy of diuretics (furosemide) along with hydration is superior to hydration alone during ESWL for renal stone clearance.Abbreviations: BMI: body mass index; KUB: kidney, ureter and bladder; OPD: Outpatient Department; ESWL: extracorporeal shockwave lithotripsy; SFR, stone-free rate. ARTICLE HISTORY

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 .…”

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

“…Furthermore, Azm et al 14 showed that the use of diuretics with ESWL improved stone clearance rate with the diuretic and ESWL clearance rate being 92.3% compared to 87% ESWL alone without diuretics in 106 ureteric calculi patients. A study by Sohu et al 15 in 714 patients reported a higher stone free rate in the diuretic group compared to the standard ESWL, 77% compared to 65% respectively (p < 0.001).…”

“…Diuretics increase urine flow around the stone during ESWL, 3,4 therefore, improving stone fragmentation 5 and removal. The main mechanism employed is the cavitation phenomenon.…”

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.…”