Optimal non-invasive treatment of 1–2.5 cm radiolucent renal stones: oral dissolution therapy, shock wave lithotripsy or combined treatment—a randomized controlled trial

Elbaset, M. A.; Hashem, Abdelwahab; Eraky, Ahmed; Badawy, Mohammed A.; El‐Assmy, Ahmed; Sheir, Khaled Z.; Shokeir, Ahmed A.

doi:10.1007/s00345-019-02746-2

Cited by 17 publications

(13 citation statements)

References 13 publications

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“…The reported success rates of oral dissolution therapy at 3 months range from 50 to 73% [17][18][19][20][21]. Some of the studies, however, included small-sized ureteral stones which might have passed spontaneously and thus account for a higher rate of "stone clearance" than our 61%.…”

Section: Discussionmentioning

confidence: 88%

“…Other studies had lower rates of complete dissolution. A prospective trial conducted by Elbaset et al assessed the efficacy of oral dissolution therapy, SWL and a combination thereof [18]. For medium-sized renal stones from 1 to 2.5 cm, the authors reported stone-free rates of 16% at one month of oral chemolysis and 50% at 3 months.…”

Section: Discussionmentioning

confidence: 99%

“…However, stones in their studies were larger compared to those in our study, supporting our finding that stone size significantly influences stone dissolution at pre-defined time points after start of oral dissolution therapy. Thus when oral chemolysis was administered for 6 months the stone-free rate increased to 83% [18]. For large stones, therefore, oral chemolysis should be prolonged to better achieve complete stone dissolution.…”

Section: Discussionmentioning

confidence: 99%

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Oral chemolysis is an effective, non-invasive therapy for urinary stones suspected of uric acid content

et al. 2020

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Despite the possible benefit from avoiding stone surgery with all its possible complications, oral chemolysis is rarely performed in patients with urinary stones suspected of uric acid content. Among the reasons for its limited use is the sparse and low-quality data on its efficacy and the lack of reliable factors predicting its outcome. We thus performed a retrospective single-center cohort study of 216 patients (median patient age 63 years) with 272 renal (48%) and/or ureteral (52%) stones treated with oral chemolysis from 01/2010 to 12/2019. Patients with low urine pH (< 6), low stone density upon non-contrast enhanced computed tomography (NCCT), radiolucent urinary stones on plain radiography, and/or a history of uric acid urolithiasis were included. Potassium citrate and/or sodium/magnesium bicarbonate were used for alkalization (target urine pH 6.5-7.2). Median stone size was 9 mm, median stone density 430 Hounsfield Units. Patients with ureteral stones < 6 mm were excluded since stones this small are very likely to pass spontaneously. The stone-free status of each patient was evaluated after 3 months using NCCT. Oral chemolysis was effective with a complete and partial response rate of stones at 3 months of 61% and 14%, respectively; 25% of stones could not be dissolved. Lower stone density (OR = 0.997 [CI 0.994-0.999]; p = 0.008) and smaller stone size (OR = 0.959 [CI 0.924-0.995]; p = 0.025) significantly increased the success rate of oral chemolysis in multivariate logistic regression analysis. More precise stone diagnostics to exclude non-uric-acid stones could further improve outcome.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Oral chemolysis is an effective, non-invasive therapy for urinary stones suspected of uric acid content

et al. 2020

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“…En efecto, existen ciertos factores que juegan un rol preponderante en el desarrollo de cálculos en el tracto urinario, entre los que vale mencionar el estilo de vida, síndrome metabólico, insuficiente ingesta hídrica, bajo volumen urinario, diabetes, obesidad, cambios climáticos (Chen et al, 2019;Chung et al, 2019;Elbaset et al, 2020).…”

Section: Introductionunclassified

“…En relación con el lito en sí, se ha descrito que a mayor densidad se reduce la tasa de éxito, por lo que se ha establecido el valor de 1000 U como punto de corte para predecir el resultado (Avendaño et al, 2018). Se estima oportuno mencionar que se considera que un caso se encuentra libre de cálculos cuando estos se encuentran ausentes o se verifica la presencia de fragmentos residuales que no condicionan sintomatología y cuyo tamaño es <3mm (Elbaset et al, 2020).…”

Section: Introductionunclassified

Litotripsia en cálculos renales

Zumba¹,

Rivadeneira²,

Dutan³

et al. 2023

LATAM

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La litiasis renal es una entidad nosológica con relevancia desde la perspectiva sanitaria y de salud pública por cuanto condiciona importantes tasas de incidencia, prevalencia y recurrencia. De allí pues que con el paso de los años se han realizado esfuerzos por establecer procedimientos altamente efectivos en el manejo de esta patología, y con baja morbilidad. La litotripsia es una de las alternativas terapéuticas más ampliamente utilizadas a escala internacional. El presente artículo tuvo como objetivo analizar la tasa de éxito de la litotripsia en pacientes con cálculos renales. Se trata de un estudio con enfoque cualitativo, en el que se realizó revisión de la literatura y posterior análisis documental. Fueron incluidos 14 artículos científicos publicados en el periodo comprendido entre 2018 – 2023, en las bases de datos Scopus, SciELO, MEDLINE, Embase y Scholar academic. De los resultados alcanzado, ha de destacarse que la litotripsia se mantiene en la actualidad como una de las alternativas terapéuticas más empleadas a nivel mundial, debido a las numerosas ventajas que conlleva y la baja morbilidad que genera, así como la tasa de éxito que en ciertos casos supera el 80%.

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Potassium sodium hydrogen citrate intervention on gut microbiota and clinical features in uric acid stone patients

Cao,

Li,

Ding

et al. 2024

Appl Microbiol Biotechnol

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The high recurrence rate of renal uric acid stone (UAS) poses a significant challenge for urologists, and potassium sodium hydrogen citrate (PSHC) has been proven to be an effective oral dissolution drug. However, no studies have investigated the impact of PSHC on gut microbiota and its metabolites during stone dissolution therapy. We prospectively recruited 37 UAS patients and 40 healthy subjects, of which 12 patients completed a 3-month pharmacological intervention. Fasting vein blood was extracted and mid-stream urine was retained for biochemical testing. Fecal samples were collected for 16S ribosomal RNA (rRNA) gene sequencing and short chain fatty acids (SCFAs) content determination. UAS patients exhibited comorbidities such as obesity, hypertension, gout, and dyslipidemia. The richness and diversity of the gut microbiota were significantly decreased in UAS patients, Bacteroides and Fusobacterium were dominant genera while Subdoligranulum and Bifidobacterium were poorly enriched. After PSHC intervention, there was a significant reduction in stone size accompanied by decreased serum uric acid and increased urinary pH levels. The abundance of pathogenic bacterium Fusobacterium was significantly downregulated following the intervention, whereas there was an upregulation observed in SCFA-producing bacteria Lachnoclostridium and Parasutterella, leading to a significant elevation in butyric acid content. Functions related to fatty acid synthesis and amino acid metabolism within the microbiota showed upregulation following PSHC intervention. The correlation analysis revealed a positive association between stone pathogenic bacteria abundance and clinical factors for stone formation, while a negative correlation with SCFAs contents. Our preliminary study revealed that alterations in gut microbiota and metabolites were the crucial physiological adaptation to PSHC intervention. Targeted regulation of microbiota and SCFA holds promise for enhancing drug therapy efficacy and preventing stone recurrence. Key points • Bacteroides and Fusobacterium were identified as dominant genera for UAS patients • After PSHC intervention, Fusobacterium decreased and butyric acid content increased • The microbiota increased capacity for fatty acid synthesis after PSHC intervention

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Optimal non-invasive treatment of 1–2.5 cm radiolucent renal stones: oral dissolution therapy, shock wave lithotripsy or combined treatment—a randomized controlled trial

Cited by 17 publications

References 13 publications

Oral chemolysis is an effective, non-invasive therapy for urinary stones suspected of uric acid content

Oral chemolysis is an effective, non-invasive therapy for urinary stones suspected of uric acid content

Litotripsia en cálculos renales

Potassium sodium hydrogen citrate intervention on gut microbiota and clinical features in uric acid stone patients

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