Abstract
ABSTRACTObjective: 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.
Highlights
Renal stones are one of the most prevalent urological health problems worldwide [1]
We hypothesised that the efficacy of diuretics along with hydration may be superior to hydration alone during extracorporeal shockwave lithotripsy (ESWL) for renal stone clearance
We investigated the efficacy of diuretics (40 mg furosemide, i.v.) along with continuous hydration (0.9% NaCl) during ESWL, with the hypothesis that it may be superior to hydration alone during ESWL for renal stone clearance
Summary
Renal stones are one of the most prevalent urological health problems worldwide [1]. The incidence, prevalence and composition of the calculi vary according to geographic location. The prevalence ranges from 5% to 9% in Europe, 7–13% in North America, and 1–5% in Asia [2]. Such differences may involve several factors including: age, sex, fluid intake, dietary habits, occupation, educational level, race, socioeconomic status, and genetics. The stones located in different sites, i.e., upper or lower urinary tract, may have different compositions. In Pakistan, the dominant components of upper urinary tract calculi are calcium oxalate (75%) and hydroxyapatite (51%) [1,5]. We hypothesised that the efficacy of diuretics (furosemide) along with hydration may be superior to hydration alone during ESWL for renal stone clearance. We assessed the effect of furosemide administered before ESWL followed by continuous infusion of 0.9% NaCl during the procedure in patients with renal stones
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