Post-ESWL, clinically insignificant residual stones: reality or myth?

Khaitan, A.; Gupta, Narmada P.; Hemal, Ashok K.; Dogra, Prem Nath; Seth, Amlesh; Aron, Monish

doi:10.1016/s0090-4295(01)01494-7

Cited by 101 publications

(50 citation statements)

References 27 publications

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“…In addition, the authors concluded that fragments of 4-5 mm and recurrent stone disease predict clinical significance [13]. They confirmed earlier findings by Khaitan et al [15], who revealed an about 50% rate of previously 'insignificant' residual stones becoming clinically significant with one more complication.…”

Section: Discussionsupporting

confidence: 81%

A Special Terpene Combination (Rowatinex®) Improves Stone Clearance after Extracorporeal Shockwave Lithotripsy in Urolithiasis Patients: Results of a Placebo-Controlled Randomised Controlled Trial

Romics

Siller

Kohnen³

et al. 2010

Urol Int

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Objective: To investigate the safety and efficacy of a special terpene combination in the treatment of patients with urolithiasis after extracorporeal shockwave lithotripsy (ESWL). Patients and Methods: 222 patients with clinically stable kidney or ureter stones of 0.3–2.0 cm undergoing complication-free ESWL were randomised to receive a special terpene combination (Rowatinex®; 3 × 2 capsules/day) or placebo. The study consisted of a 12-week active treatment phase and a 2-week follow-up phase. All patients had a physical examination, and diagnosis of kidney stones was made by X-ray, intravenous pyelogram or ultrasound at weeks 1, 4, 8 and 12 as well as after 2 weeks of follow-up. Stone-free status was defined as obviously successful expulsion of calculi/fragments, being without any stone. Results: In all, when compared to placebo, significantly more patients receiving the terpene combination treatment in the intent-to-treat (ITT) group [72 (67.9%) vs. 49 (50.0%); p = 0.0009] and the per-protocol (PP) group [69 (78.4%) vs. 48 (52.2%); p = 0.0004] were stone-free at the end of the study. Treatment with the terpene combination was also more effective when analysed with respect to the size of the treated stone. In addition, treatment with the terpene combination significantly reduced the median time to stone-free status from 85.0 to 56.0 days (p = 0.0061) and from 85.0 to 49.5 days (p = 0.0028) in the ITT and PP populations, respectively. Nine mild-to-moderate adverse events (AE; terpene combination group: 7 AE in 4 patients; placebo group: 2 AE in 2 patients) were assessed as drug-related. Conclusions: Treatment with the terpene combination is well tolerated and safe. The terpene combination was found to be an efficacious treatment in eliminating calculi fragments generated by ESWL as compared to placebo. The pharmacodynamic properties of the terpene combination (antilithogenic, antibacterial, antiinflammatory, spasmolytic and analgesic effects), which have been also confirmed in preclinical studies, represent a valuable alternative to the different drugs used in the treatment of urolithiasis.

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Section: Discussionsupporting

confidence: 81%

A Special Terpene Combination (Rowatinex®) Improves Stone Clearance after Extracorporeal Shockwave Lithotripsy in Urolithiasis Patients: Results of a Placebo-Controlled Randomised Controlled Trial

Romics

Siller

Kohnen³

et al. 2010

Urol Int

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“…1,2 However, even with advanced technology today, single procedure stone-free rates as low as 50% have been reported. 3,4 The current approach to endoscopic stone management is fragmentation and extraction of larger fragments, leaving small, socalled clinically insignificant residual fragments to pass.…”

mentioning

confidence: 99%

Novel Iron Oxide Microparticles Used to Render Stone Fragments Paramagnetic: Assessment of Toxicity in a Murine Model

et al. 2012

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“…Khaitan et al [27] demonstrated that clinically insignificant fragments could regrew in 59% of patients who were followed up to 60 months. Same authors were also mentioned that pain, recurrent urinary tract infections, increase in the number of stones, ureteric obstruction, hematuria, non-functioning lower pole and hypertension were the potential complications of these fragments and while 16 patients among 44 complicated cases whom the fragment became clinically significant underwent additional SWL, more invasive treatments such as percutaneous nephrolithotripsy, ureterorenoscopy and partial nephrectomy were needed in 3, 4 and 1 cases, respectively [27]. So, helical CT can aware us about these probable complications at least in patients who had residual stones 2-4 mm.…”

Section: Discussionmentioning

confidence: 99%

Value of Ultrasonography and Helical Computed Tomography in the Diagnosis of Stone-Free Patients after Extracorporeal Shock Wave Lithotripsy (USG and Helical CT after SWL)

et al. 2005

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Although plain abdominal X-ray has been accepted as the first line diagnostic tool in the follow-up after SWL with its cheap and practical use, helical CT was found to be more valuable in diagnosis of residual stone fragments which has not been found in plain abdominal X-ray. If we take these considerations which can change our clinical approach and patient follow-up into account, we believe that the routine use of helical CT can give more accurate information in patient controls after SWL.

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Post-ESWL, clinically insignificant residual stones: reality or myth?

Cited by 101 publications

References 27 publications

A Special Terpene Combination (Rowatinex®) Improves Stone Clearance after Extracorporeal Shockwave Lithotripsy in Urolithiasis Patients: Results of a Placebo-Controlled Randomised Controlled Trial

A Special Terpene Combination (Rowatinex®) Improves Stone Clearance after Extracorporeal Shockwave Lithotripsy in Urolithiasis Patients: Results of a Placebo-Controlled Randomised Controlled Trial

Novel Iron Oxide Microparticles Used to Render Stone Fragments Paramagnetic: Assessment of Toxicity in a Murine Model

Value of Ultrasonography and Helical Computed Tomography in the Diagnosis of Stone-Free Patients after Extracorporeal Shock Wave Lithotripsy (USG and Helical CT after SWL)

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