Protective Effect of Verapamil on Renal Tissue During Shockwave Application in Rabbit Model

Abstract

Although extracorporeal shockwave lithotripsy (SWL) is the treatment of choice for symptomatic urinary calculi, it has been shown in number of studies that adverse effects of high-energy shockwaves may be encountered in short- and long-term follow-up. To evaluate the possible protective effect of verapamil administration on renal tissue, both magnetic resonance imaging (MRI) and histopathologic examination were performed after SWL in rabbits. Thirty-five animals were divided into three groups. The 15 animals in the first group were fed verapamil (0.1 mg/kg) for 3 days. Another 15 animals received no medication but underwent SWL, and the remaining 5 animals received anesthesia alone (sham group). The animals were then subdivided into three groups according to the shockwave number applied (1000, 15,000, or 2000) and the aforementioned evaluations were performed 24 hours and 3 months after the procedure. We found prominent histopathologic alterations in animals not receiving any medication before SWL. Persistence of these pathologic alterations during 3 months of follow-up indicated the importance of preservation of renal architecture during high-energy shockwave application. On the other hand, animals under verapamil medication prior to SWL demonstrated only a limited degree of histopathologic alteration. Demonstration of a normal histologic pattern after 3 months supported the preservation of tissue structure by such medication. No significant histopathologic alteration could be observed in the sham-group animals, as expected. Our study demonstrates that verapamil is protective against shockwave-induced renal tubular damage. Such medications may be useful to avoid the proven histopathologic and functional side effects of high-energy shockwaves.

Morphological changes induced in the pig kidney by extracorporeal shock wave lithotripsy: Nephron injury

“…In addition, other researchers proposed that oxidative stress associated with ischemia induced by SWL may also contribute to the resulting tissue injury (Sarica et al, 1996a;Cohen et al, 1998;Brown et al, 2000;Munver et al, 2002). Support for a possible role of oxidative stress in the tubular injury caused by shock waves comes from several studies in which inhibitors of oxidative stress reduced the urinary excretion of enzymatic markers of tubular injury (Strohmaier et al, 1991(Strohmaier et al, , 1993(Strohmaier et al, , 1994a(Strohmaier et al, , b, 1999(Strohmaier et al, , 2002Benyi et al, 1995;Ogiste et al, 2003) or diminished the histological signs of tissue injury (Fegan et al, 1991;Yaman et al, 1996;Sarica et al, 1997;Biri et al, 1998) after SWL. The precise role of oxidative stress in shock wave-induced injury (i.e., cause or effect, both, or none) remains to be determined.…”

Reduction of shock wave lithotripsy-induced renal tubular injury by tadalafil

“…Verapamil, an organ-protective calcium antagonist is one of these agents. It has an excellent stabilizing effect on post ischemic malperfusion, and has been found to be benefi cial in this respect (22). Nifedipine exhibits a protective effect on shock-wave-induced tubular damage similar to verapamil (23).…”

Unilateral Testicular Torsion: Protective Effect of Verapamil on Contralateral Testicular Histology

“…In an attempt to decrease the effects of the ischemic insult to the contralateral testicle, some methods of attenuating testicular damage have been studied, including the use of surfactants, ciclosporin, prednisone, inosine, superoxide dismutase, catalase, a platelet-activating factor antagonist, and hypothermia -with varying success rates [7,10,19,21]. Related to this subject, verapamil (a calcium channel blocking agent) has been found to be protective enough because of its specific effects on hemodynamics of different organs [23].…”

“…After observing all these histological alterations, physicians begin to search for protective agents to minimize blood flow decrease and histological alterations. Verapamil (a calcium channel blocking agent) has been found to be protective because of its specific effects on hemodynamics of different organs [23].…”