The combination of furosemide and intravenous hydration does not affect the success of shock wave lithotripsy in renal stone treatment: a prospective randomised single blinded trial

Kocaaslan, Ramazan; Kucukpolat, S.; Karadağ, Mert Ali; Erkan, Erkan; Kadıhasanoğlu, Mustafa; Özyalvaçlı, Mehmet Emin; Toktas, Mahmut Gokhan

doi:10.1136/ejhpharm-2015-000693

Cited by 6 publications

(15 citation statements)

References 10 publications

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“…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 .…”

Section: Resultsmentioning

confidence: 99%

Furosemide improves the stone clearance rate of extracorporeal shockwave lithotripsy for kidney stones but not ureteral stones: a systematic review and meta-analysis

Feng

Huang

et al. 2022

Therapeutic Advances in Urology

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Introduction: We conducted a meta-analysis (MA) to investigate the effects of furosemide on the prognosis of extracorporeal shockwave lithotripsy (SWL) therapy to remove renal (RS) and ureteric stones (US). Methods: We screened scientific databases including PubMed, Clinicalkey, Google Scholar, Medline, Embase, and Cochrane, from the date of establishment until March 2022, to search for randomized controlled trials evaluating SWL, in combination with furosemide (experimental group) or with SWL alone (control group), in treating RS or US. Our search terms included furosemide, extracorporeal SWL, and urolithiasis. For this MA, we employed the Cochrane Collaboration’s RevMan version 5.3.0. Results: Six trials, involving 1344 participants, with RS ( n = 1097) and/or US ( n = 247), met our predefined criteria. This included 137 proximal ureteral stones (PUSs), 35 mid-ureteral stones (MUS), and 75 distal ureteral stones (DUS). In case of RS, the experimental group exhibited significantly enhanced clearance, relative to controls (risk ratio [RR] = 1.16, 95% confidence interval [CI] = 1.07–1.25, p = 0.0002), yet there was no obvious difference in the PUS, MUS, and DUS (RR = 1.14, 95% CI = 0.97–1.33, p = 0.10; odds ratio [OR] = 1.26, 95% CI = 1.40–3.95, p = 0.69; RR = 1.21, 95% CI = 0.99–1.49, p = 0.06). There was also no marked difference between fragmentations in either group. Only reports of SWL treatment of RS provided adequate data on shocks, sessions, and complications for our analysis. Unfortunately, there was no significant alteration between the two groups. Conclusion: According to our analysis, furosemide strongly accelerates the clearance rate of SWL-treated RS. However, it does not enhance the fragmentation rate. Given this evidence, we propose that furosemide does not significantly improve the efficacy of SWL therapy in removing US. Registration: Our work is registered with PROSPERO (CRD42020204780).

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Section: Resultsmentioning

confidence: 99%

Furosemide improves the stone clearance rate of extracorporeal shockwave lithotripsy for kidney stones but not ureteral stones: a systematic review and meta-analysis

Feng

Huang

et al. 2022

Therapeutic Advances in Urology

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“…The calculus fragmentation and 3-month SFR were 93.3% and 87.5%, respectively for ESWL with diuresis compared to 70.6% (for fragmentation) for ESWL without diuresis. However, a Turkish single-blinded randomised controlled trial [15], showed that the comparison of the treatment group with the control group had no statistically significant difference in the average number of sessions, number of pulses and total energy used; that is, no benefit was obtained with the additional treatment. In that study the SFR was 71% and 69% in the treatment group and control group, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Renal patients are usually in a state of relative dehydration, due to use of purgatives the night before, which improves its effectiveness and fasting until the next day. The dehydration caused by relative oliguria might have a negative effect on stone fragmentation and the fluid film surrounding the stone reportedly enables improved fragmentation of the stone [15]. So, if the treated kidney's function has deteriorated due to the obstruction, the dehydration hinders adequate urine flow around the stone [18].…”

Section: Discussionmentioning

confidence: 99%

“…So, if the treated kidney's function has deteriorated due to the obstruction, the dehydration hinders adequate urine flow around the stone [18]. Diuretics will increase urine flow and thus the probability of cavitation [19,20]; which means, pieces of the broken stone shell increase, and the centre of the stone is exposed to subsequent shockwaves allowing entry of urine through the broken surface, thus giving an adequate interface with the centre of the stone [15]. The size of the stone is an important prognostic factor for successful ESWL and is considered as a highly effective treatment option for lower pole stones ≤2 cm [21].…”

Section: Discussionmentioning

confidence: 99%

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

Sohu

Soomro

Mangrio

et al. 2019

Arab Journal of Urology

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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

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“…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.…”

Section: Characteristics Of Individual Studiesmentioning

confidence: 99%

Faculty Opinions recommendation of The efficacy and safety of diuretics on extracorporeal shockwave lithotripsy treatment of urolithiasis: A systematic review and meta analysis.

Tiselius

2020

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature

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Background: The aim of this systematic review and meta-analysis was to demonstrate the efficacy and safety of diuretics on extracorporeal shockwave lithotripsy (SWL) treatment of urolithiasis. Methods: The databases MEDLINE, EMBASE, and the Cochrane Controlled Trial Register of Controlled Trials from January 1980 until November 2019 were searched to identify randomized controlled trials that referred to the use of diuretics on extracorporeal SWL treatment of urolithiasis. Results: Six randomized controlled trials containing 1344 patients were included in this meta-analysis, which compared diuretics with placebo on extracorporeal SWL treatment of urolithiasis. In the analysis, we found that diuretics on extracorporeal SWL treatment were more effective for the management of urinary stones. Compared with placebo, patients who received diuretics during extracorporeal SWL treatment had significantly higher successful stone clearance rate (Odds ratio; 1.73, 95% confidence interval (CI); 1.35 to 2.21, P < .0001), higher stone fragmentation rate (odds ratio; 2.83, 95% CI; 1.30 to 6.16, P = .009), less average number of sessions per stone (mean difference;-0.13; 95% CI,-0.25 to-0.01, P = .03) and similar average number of shocks per stone (mean difference;-126.89; 95% CI,-394.53 to 140.76, P = .35). Conclusion: This systematic review and meta-analysis indicates that diuretics during extracorporeal SWL was effective in the management of urolithiasis with lower risk of complications. Abbreviations: CI = confidence interval, MD = mean difference, OR = odds ratio, PCNL = percutaneous nephrolithotomy, RCT = randomized controlled trial, RIRS = retrograde intrarenal surgery, SWL = shockwave lithotripsy.

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The combination of furosemide and intravenous hydration does not affect the success of shock wave lithotripsy in renal stone treatment: a prospective randomised single blinded trial

Cited by 6 publications

References 10 publications

Furosemide improves the stone clearance rate of extracorporeal shockwave lithotripsy for kidney stones but not ureteral stones: a systematic review and meta-analysis

Furosemide improves the stone clearance rate of extracorporeal shockwave lithotripsy for kidney stones but not ureteral stones: a systematic review and meta-analysis

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

Faculty Opinions recommendation of The efficacy and safety of diuretics on extracorporeal shockwave lithotripsy treatment of urolithiasis: A systematic review and meta analysis.

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