Our Experience with Nifedipine and Prednisolone as Expulsive Therapy for Ureteral Stones

Saita, Alberto; Bonaccorsi, A.; Marchese, Francesco P.; Condorelli, S; Motta, Marcel Machado da

doi:10.1159/000076591

Cited by 51 publications

(39 citation statements)

References 8 publications

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“…3,4 In the review by Hollingsworth and colleagues, the results of MET administered with calcium channel blockers and alpha blockers were evaluated in 9 randomized, controlled studies. When compared with the control groups, these agents caused 65% more spontaneous passage of stones.…”

Section: Introductionmentioning

confidence: 99%

Can the Hounsfield unit predict the success of medically expulsive therapy

Erturhan

Bayrak

Mete

et al. 2013

CUAJ

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Background: We investigate the predictability of medical expulsive therapy (MET) success with alpha blockers based on Hounsfield unit (HU) values and Hounsfield density (HD) values measured by computed tomography (CT) for distal ureteral stones. Methods: Between July 2011 and May 2012, 44 patients (19 female and 25 male) with 5-to 10-mm stones in the distal ureters were included in this randomized prospective study. Non-contrast CT examinations were performed in these patients. HU and HD values of stones were calculated. Doxazosine, 4 mg/day orally, was administered as a single dose to all patients for MET. Results: Patients were divided into 2 groups. Group 1 included 18 patients (43.9%) with dropped stones with MET. Group 2 included 23 patients (56.1%) with no stone passage with MET. In Group 1, the mean stone size was 7.7 mm, the mean HU was 507, and the HD was 53.04/mm. In Group 2, the mean stone size was 8.25 mm, the mean HU was 625, and the mean HD was 61.54/mm. The HU and HD values in Group 2 were higher than in Group 1. However, there was no statistically significant difference (p = 0.85 and 0.93 for HU and HD, respectively). Interpretation: We found that HU and HD values cannot be used to predict the chances of success for MET. Although the sample size is appropriate for the study, further comparative studies involving more patients are warranted.

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Section: Introductionmentioning

confidence: 99%

Can the Hounsfield unit predict the success of medically expulsive therapy

Erturhan

Bayrak

Mete

et al. 2013

CUAJ

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“…Studies by Saita and colleagues and Borghi and colleagues both demonstrated clinical significance in increasing expulsion rates of distal ureteral stones in patients who received combined methylprednisolone and nifedipine therapy. 19,20 No significant side effects were described in either study.…”

Section: Corticosteroidsmentioning

confidence: 78%

“…Alpha-blockers have been described to be significantly better than nifedipine in facilitating stone passage and relieving renal colic. 19,17,21 As a result, the most recent EAU guidelines do not recommend calcium channel blockers as a monotherapy for MET. 2 However, it may be safely used in conjunction with alpha-blockers in the appropriate patient population as side effects have been found to be insignificant.…”

Section: Calcium Channel Blockersmentioning

confidence: 99%

Update on medical expulsive therapy for distal ureteral stones: Beyond alpha-blockers

Bos

Kapoor

2014

CUAJ

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Medical expulsive therapy (MET) has been described as an effective conservative treatment option in the initial management of small distal ureteral stones. Therapies that have been investigated include alpha-blockers, calcium channel blockers, corticosteroids, and most recently phosphodiesterase-5 inhibitors (PDE5) inhibitors. While alpha-blockers are currently the only recommended monotherapy, corticosteroids have received increased attention as a potential useful adjunct in the medical management of distal stones. PDE5 inhibitors are a novel treatment alternative, requiring further investigation. This review provides an overview of recent MET best practices, with a focus on novel therapies beyond alphablockers.

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“…One study by Saita (2004) All studies that examined corticosteroids treated distal ureteral stones only, except one study that examined all ureteral stones. Most studies included radiopaque stones only which lead to a gap in knowledge about corticosteroids for non-radiopaque stones like cystine and uric acid stones [39].…”

Section: Discussionmentioning

confidence: 99%

The role of corticosteroids in the management of kidney stones disease: a systematic review

Nouri¹,

Hassali²,

Hamza³

2017

clinical-practice

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Background: Therapy for kidney stones disease has undergone many changes in the last decades. Medical expulsive therapy such as alpha-blockers and calcium channel blockers regarded as effective agents for stones expulsion and colic pain alleviation. However, many studies have used corticosteroids to utilize their actions in urolithiasis management as well. Objectives:To determine the role of corticosteroids in the management of urolithiasis in terms of stone expulsion rate and stones expulsion time. Methods:Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement, a literature search using electronic databases including Pub Med, Google Scholar, and Science Direct was undertaken. Full text, prospective, English published studies were included.Results: Initial search identified 1261 studies. By excluding duplicates, irrelevant titles, and articles that don't fulfil the inclusion criteria, six articles were included. The included studies were conducted in three countries that was published between 2000 and 2016. All studies examined patients with ureteral stones. The corticosteroids used were (deflazacort, methylprednisolone, and prednisolone); each trial used one of them as monotherapy or in combination with another medical expulsive therapy agent. The retrieved studies achieved their objectives by investigating stone expulsion rates and stone expulsion time mainly. Conclusions:Corticosteroids can improve the action of medical expulsive drugs when combined with nifedipine or alfa-antagonists for the treatment of ureterolithiasis. In which, reduction of the time for stone passage was statistically significant in most studies while corticosteroids monotherapy was not effective by any means. However, future prospective research studies are required to determine the corticosteroids actual role in the management of urinary tract stones and the worthiness of its combination.

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Our Experience with Nifedipine and Prednisolone as Expulsive Therapy for Ureteral Stones

Cited by 51 publications

References 8 publications

Can the Hounsfield unit predict the success of medically expulsive therapy

Can the Hounsfield unit predict the success of medically expulsive therapy

Update on medical expulsive therapy for distal ureteral stones: Beyond alpha-blockers

The role of corticosteroids in the management of kidney stones disease: a systematic review

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