Management Of Urinary Stones Research Articles

Actual clinical practice pattern in SWL after COVID-19 era: a critical evaluation from different aspects.

To outline the current status of Shock Wave Lithotripsy (SWL) in stone treatment and the changes in the mode of application after the COVID-19 pandemic along with critical factors affecting the clinical practice of this particular procedure. This study targeted national and international urology experts who could share and contribute their experiences and perspectives on SWL practices after COVID-19 era. Approximately 650 urology specialists were invited to participate in the survey based study via Google Forms. Participation was voluntary and 398 of the invited participants completed the survey, yielding an acceptable response rate of approximately 61.23%. This survey highlights significant findings that shed light on the changes in clinical SWL applications. Nearly half of SWL procedures are performed by technicians or nurses instead of experienced urologists, potentially affecting the proper application and outcomes of the procedure. SWL seemed to be applied on a guideline (GL) indications based manner by the majority of the participants. Fluoroscopy remains still as the most commonly used method for radiological assessment, underscoring the necessity to teach sonography applications to younger urologists. Key reasons for the limited clinical application of SWL include the absence of lithotripters in the departments, high lithotriptor costs and significantly lower reimbursement rates compared to PNL and fURS modalities. Finally, an increase in SWL utilization rates has been observed post-COVID-19, highlighting its certain advantages realized during this period. These findings provide important insights into the role of SWL in stone treatment and the main factors influencing its clinical application practices. Although the popularity of SWL in the management of urinary stones is being stated to decline particularly in the last two decades, data obtained in this survey emphasized well that it is still a viable option especially for stones smaller than 15mm. Our findings highlight the enduring relevance of SWL in contemporary stone therapy protocols in the context of COVID-19, where outpatient, non-invasive procedures are preferred. In addition to the consideration of certain factors affecting the rate of its application in clinical practice, to achieve high success rates with minimal complications in SWL, strategic patient selection and adherence to procedure guidelines seem to be crucial.

Pharmacotherapy for patients with calcium oxalate stones and abnormal urine chemistry: A systematic review and meta-analysis for the Japanese Clinical Practice Guidelines for the Management of Urinary Stones, Third Edition.

We performed a systematic review and meta-analysis to evaluate the benefits and harms of pharmacotherapies for patients with calcium oxalate stones and abnormal urine chemistry. This article is a modified and detailed version of the commentary on Clinical Question 10 described in the Japanese Clinical Practice Guidelines for the Management of Urinary Stones, Third Edition. PubMed and Ichushi Web were searched through August 2020 for articles on pharmacotherapies for calcium oxalate stones (thiazides, citrate preparations, uric acid production inhibitors, and magnesium preparations). Two reviewers independently selected randomized controlled trials reporting reduction of stone recurrence and adverse drug reactions as outcomes and performed data extraction and quality assessment. Meta-analyses with random effects models and rating of the strength of evidence were performed. Pharmacotherapies were shown to significantly reduce stone recurrence (risk ratio 0.47, 95% confidence interval 0.35-0.63). Meanwhile, the pharmacotherapies increased adverse drug reactions leading to study dropout (risk ratio 2.51, 95% confidence interval 1.09-5.75) and adverse drug reactions/adverse events (risk ratio 1.95, 95% confidence interval 1.07-3.56). The reported adverse drug reactions were, however, mainly minor and did not frequently require discontinuation of medication (2%-16%). The strengths of evidence for both outcomes were rated as moderate, because the risk of bias, indirectness, inconsistency, imprecision, and publication bias were all serious except for one item. The overall strength of evidence across outcomes was therefore determined to be moderate. These results support the conditional recommendation to initiate pharmacotherapies for patients with calcium oxalate stones and abnormal urine chemistry.

Does Silodosin Improve Primary Ureteroscopy Access and Outcomes: Meta-Analysis of Randomized Controlled Trials.

Background: Ureteroscopy (URS) is a widely utilized procedure for the management of urinary stones, though failed access due to ureteral orifice tightness or spasms can be a potential outcome. Silodosin, an alpha-1A adrenergic receptor antagonist, has shown promise in recent randomized controlled trials (RCTs) in improving URS outcomes by relaxing ureteral smooth muscle. Objective: This systematic review and meta-analysis aims to determine whether preoperative administration of silodosin enhances ureteroscopy outcomes, including ureteral access rates, operative time, complication rates, and stone-free rates. Methods: After PROSPERO registration, a comprehensive search of PubMed, EMBASE, and the Cochrane Library was conducted for RCTs comparing silodosin with placebo or no medication before URS. Data extraction and bias assessment were performed independently by two reviewers. Statistical analysis was undertaken by Review Manager V5.4, employing random-effects models for heterogeneous variables. Results: Eight RCTs with a total of 892 patients (416 in the silodosin group and 476 in the control group) met the inclusion criteria. Silodosin significantly reduced operative time by 15.74 minutes (p < 0.00001). The access rate was higher in the silodosin group (96.9%) compared with the control group (87.2%)(p = 0.0004). Total complication rates were lower in the silodosin group (14.39% vs 27.47%, p < 0.00001), as were moderate to significant complications (5.0% vs 11.7%, p = 0.003). Stone-free rates were also higher in the silodosin group (92.16% vs 81.5%, p < 0.0001). Conclusion: Preoperative administration of silodosin significantly improves URS outcomes by reducing operative time, increasing access rates, decreasing complication rates, and enhancing stone-free rates. These findings support the integration of silodosin into clinical practice guidelines for URS, potentially improving procedural efficiency and patient outcomes.

317 A Trust-Wide Assessment of Follow-Up Care &amp; Success Rates for the Conservative Management of Urinary Stones

317 A Trust-Wide Assessment of Follow-Up Care &amp; Success Rates for the Conservative Management of Urinary Stones

Management of urinary stones: state of the art and future perspectives by experts in stone disease.

Management of urinary stones: state of the art and future perspectives by experts in stone disease.

Extracorporeal shockwave lithotripsy in the management of urinary stones: New concepts and techniques to improve outcomes

ObjectiveExtracorporeal shockwave lithotripsy (SWL) currently plays an important role in the treatment of urinary tract lithiasis. The purpose of this article was to describe new concepts and procedural strategies that would improve results using SWL as a treatment for urolithiasis, thereby achieving best clinical practice. MethodsA systematic review process was carried from 2003 to 2023. A narrative synthesis of the most important aspects has been made. ResultsThe important recommendations for the adequate selection of the candidate patient for treatment with SWL are summarized, as well as the new strategies for a better application of the technique. Aspects about intraoperative position, stone localization and monitoring, analgesic control, machine and energy settings and measures aiming at reduced risk of complications are described. ConclusionTo achieve the therapeutic goal of efficient stone disintegration without increasing the risk of complications, it is necessary to make an adequate selection of patients and to pay special attention to several important factors in the application of treatment. Technological development in later generation devices will help to improve current SWL results.

Initial experience with the graphical user interface for laser parameters setting of a new thulium fibre laser source device for urinary pathologies treatment.

We aimed to evaluate the concordance between the pre-settings ranges of thulium fibre laser (TFL) (Coloplast TFL Drive, Denmark) with easy-to-use graphical user interface and the laser settings used by a high-volume endo-urologist during surgical procedures. In October 2022, we prospectively collected data of 67 patients who underwent TFL Drive (Coloplast, Denmark) for the management of urinary stones. Urothelial tumour (upper tract urinary cancer (UTUC) and bladder) 200 and 150μm laser fibres were used for procedures. Stones characteristics (size and density) tumours and stenosis localizations, laser-on time (LOT), and laser settings were recorded. We also assessed the ablation speed (mm3/s), laser power (W), and Joules/mm3 values for each lithotripsy. A total 67 patients took part in the study. Median age was 52 (15-81)years. 55 (82%), 8 (12%), and 4 (6%) patients presented urinary stones, urothelial tumour, and stenosis, respectively. Median stone volume was 438 (36-6027)mm3 and median density was 988 (376-2000) HU. Median pulse energy was 0.6 (0.3-1.2), 0.8 (0.5-1) and 1J for urinary stones, urothelial tumour and stenosis respectably. Endoscopically stone-free rate was 89%. Graphical user interface and surgeon accordance with the safety range were observed in 93.2%, 100% and 100% for urinary stones, UTUC and stenosis, respectively. During endoscopic procedures for urinary stones treatment, it is frequently needed to change laser parameters. These new TFL and GUI technology parameters remained in the pre-set security range in 94.1% of procedures.

Innovations in Minimally Invasive Techniques for Urinary Stone Management

The therapy of urinary stones has undergone a revolution because to minimally invasive procedures, which offer less recovery time and lower morbidity than open surgery. This extensive study delves into the latest developments in laser lithotripsy, ureteroscopy, shockwave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), and new technologies. The investigation looks closely at these novel techniques' effectiveness, drawbacks, and changing patterns. Improvements in patient screening criteria and shockwave delivery devices, among other technological advancements in SWL, have maximised therapy results. Advances in URS, such as flexible ureteroscopes and sophisticated imaging modalities, have increased accuracy and broadened the range of stones that may be treated. PCNL's advancements in imaging and equipment miniaturisation have increased access and stone fragmentation efficiency. With its accuracy and variety of fibre shapes, laser lithotripsy is becoming a more attractive option. Looking ahead, the main concerns are going to be technology integration, tailored medication, and all-encompassing patient-centered care. For adoption to be widely adopted, issues with cost, accessibility, and complexities must still be resolved.

Efficacy of a Multicomponent Nutraceutical Formulation for the Prevention and Treatment of Urinary Tract Stones.

Urolithiasis is a complex and multifactorial disease characterized by the formation of calculi at the urinary tract level. Conventional therapeutic prophylaxis relies on the use of Ca-blockers, alkalis, diuretics, and anti-edema agents, but their prolonged utilization is often limited by several side effects. In this scenario, the aim of the present work was the design of an innovative multi-component nutraceutical formulation (NF) for the management of urinary stones consisting of a synergistic combination of natural aqueous extracts of Oreganum vulgare L. (1% of saponin), Urtica dioica (0.8% of β-sitosterol), Phyllanthus niruri (15% of tannins w/w), and Ceterach officinarum in association with bromelain, K, and Mg citrate. To assess the potential of NF also in the treatment of uric acid (UA) stones, the effects on the expression of the cellular UA transporters OAT1 and URAT1 were investigated in a renal tubular cell line. In addition, the myorelaxant effect of NF was investigated in a human pulmonary artery smooth muscle cell (HPASMC) model resulting in a decreased muscle contractility of -49.4% (p < 0.01) compared to the control. The treatment with NF also showed a valuable inhibition of in vitro calcium-oxalate crystal formation, both in prevention (-52.3% vs. control, p < 0.01) and treatment (-70.8% vs. control, p < 0.01) experiments. Finally, an ischemic reperfusion rat model was used to evaluate the NF anti-edema effects, resulting in a reduction in the edema-related vascular permeability (Normalized Gray Levels, NGL = 0.40 ± 0.09, p < 0.01, -67.1% vs. untreated rats). In conclusion, the present NF has shown to be a promising natural alternative for managing urinary tract stones.

Tribulus Terrestris and its Efficacy in the Treatment of Urinary Calculi

Background: Urolithiasis as the third most common disorder is defined as stones within the urinary tract. Calcium oxalate is the most common type of stone with a prevalence of 80-85% of cases. There is no drug treatment for urolithiasis, but the use of some stone blockers and inhibitors relaxes the ureter smooth muscles and helps the stone excretion. Objective: High prevalence and recurrence rates of urolithiasis has encouraged scientists to find new drugs, especially from medicinal plants. Tribulus terrestris is used for the management of urinary calculi in different traditional systems. Therefore, the potential use of T. terrestris in the management of urinary stones has been the subject of this review for the first time. Methods: The manuscript was prepared by searching the keywords “Tribulus terrestris”, “urolithiasis”, “urinary stone”, and “calcium oxalate” in scientific resources, traditional and modern books, dissertations, and documents. Results: The results exhibited that T. terrestris fruit aqueous extract had some efficacy in the treatment of urinary calculi by demineralizing the stone, inhibiting the stone formation, increasing urine volume in 24 hrs in animal and human studies, along with protective effects against renal injury due to inhibition of oxidative stress and lipid peroxidation. Conclusion: All these mechanisms make T. terrestris as an effective treatment for urolithiasis that needs to be evaluated in further clinical studies.

This Month in Adult Urology.

This Month in Adult Urology.

Incidence and risk factors for urolithiasis recurrence after endourological management of kidney stones: A retrospective single-centre study.

Almost half of the patients have hadrecurrent nephrolithiasis despite undergoing effective treatment. Our objective is to determine the recurrence rate of lithiasis after endourological management of nephrolithiasis and identify the risk factors for these recurrences. Data were gathered retrospectively from all patients who were treated for nephrolithiasis by endourological management from May 2014 to January 2017 in our university hospital. The patients were devised into two groups: with and without recurrence. Many variables were also compared between these two groups. During this period 265 patients were treated for upper urinary tract stone. A total of 190 patients were included in the study. The median age and median BMI of the patients were 57.5 years and 25.2kg/m2, respectively. A biochemical analysis of the stones was performed in 117 (61.5%) patients. The most common types of stones were calcium oxalate monohydrate stones (n=44, 23.2%), mixed stones (n=39, 20.5%) including mixed calcium oxalate (n=10; 8.5%), calcium oxalate dihydrate stones (n=13, 6.8%) and uric acid stones (n=11, 5.8%). At the end of a median follow-up of 32 months (range, 13-61 monthes), 49 patients (25.8%) had a recurrent stone. In univariate analysis, the risk factors for recurrence were BMI greater than 25kg/m2 (HR: 2; P<0.05), diabetes (HR: 3.73; P<0.008) and smoking (HR: 3.1; P<0.039). However age (HR: 0.96: P<0.003) and high blood pressure (HR: 0.37; P<0.027) were protective factors. In multivariate analysis, diabetes, smoking, hypertension, and age are still risk factors for recurrence. Stone recurrence is common after the management of urinary stones. In this study25.8% of patients had recurred stone disease after endourological management with a median follow-up of 32 months. Our study findings showed that diabetes and smoking are risk factors for recurrence, while age and blood hypertension are protective factors that decreased the risk of recurrence.

PD55-05 WORLDWIDE SURVEY ON THE CURRENT PRACTICE OF ASYMPTOMATIC URINARY STONE MANAGEMENT: A SURVEY FROM EAU, YOUNG ACADEMIC UROLOGISTS (YAU), ENDOUROLOGY AND UROLITHIASIS WORKING PARTY

You have accessJournal of UrologyCME1 May 2022PD55-05 WORLDWIDE SURVEY ON THE CURRENT PRACTICE OF ASYMPTOMATIC URINARY STONE MANAGEMENT: A SURVEY FROM EAU, YOUNG ACADEMIC UROLOGISTS (YAU), ENDOUROLOGY AND UROLITHIASIS WORKING PARTY Tarik Emre Sener, Thomas Tailly, Amelia Pietropaolo, Etienne Xavier Keller, Yiloren Tanidir, Juan Gomez Rivas, Zeeshan Hameed, Vincent De Coninck, Tzevat Tefik, Kemal Sarica, Ali Serdar Gozen, Andreas Skolarikos, Olivier Traxer, and Bhaskar Somani Tarik Emre SenerTarik Emre Sener More articles by this author , Thomas TaillyThomas Tailly More articles by this author , Amelia PietropaoloAmelia Pietropaolo More articles by this author , Etienne Xavier KellerEtienne Xavier Keller More articles by this author , Yiloren TanidirYiloren Tanidir More articles by this author , Juan Gomez RivasJuan Gomez Rivas More articles by this author , Zeeshan HameedZeeshan Hameed More articles by this author , Vincent De ConinckVincent De Coninck More articles by this author , Tzevat TefikTzevat Tefik More articles by this author , Kemal SaricaKemal Sarica More articles by this author , Ali Serdar GozenAli Serdar Gozen More articles by this author , Andreas SkolarikosAndreas Skolarikos More articles by this author , Olivier TraxerOlivier Traxer More articles by this author , and Bhaskar SomaniBhaskar Somani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002635.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Management of asymptomatic kidney stones is a topic of ongoing debate with follow-up and treatment guidelines based on low-level evidence. Our aim was to evaluate current management of asymptomatic urinary stones. METHODS: A 70-question survey was designed in collaboration with EAU, Young Academic Urologists (YAU), Section of Uro-Technology (ESUT) and Section of Urolithiasis (EULIS) groups and distributed. Responders filled out several clinical scenarios either as counselling urologists, or as patients themselves. RESULTS: A total of 212 (30.2%) responses were obtained. Median responder age was 39 years. Demographic information is given in Table 1. 159 (75%) responders were interested in “urolithiasis”. 175 (82.5%) had never experienced a renal colic and 89.6% had never undergone any kind of urolithiasis treatment.Overall, urologists as patients themselves opted significantly more frequently for a conservative approach (29% vs. 25%) or SWL (17% vs. 14%), and significantly less frequently for a URS (35% vs. 39%) or PCNL (19% vs 23%), compared to what urologists would recommend to their patients (p <0.001) (Figure 1A).Of all demographic parameters, having had a renal colic was an independent predictor of an interventional approach (OR 1.5, 95% CI 1.1-2.0; p=0.01), whereas having had an intervention was an independent predictor of a conservative approach (OR 1.01, 95% CI 1.01-1.19; p=0.04). Overall, no significant differences in follow-up schedules were found between urologists and urologists as patients themselves (Figure 1B and 1C). Only 19% of all kidney stones were adjourned for follow-up within 3 months, compared to 89% for ureteral stones (p<0.001). CONCLUSIONS: Current treatment and follow-up patterns of asymptomatic urinary stones are in agreement with international guidelines on symptomatic stones. Urologists tend to choose the lesser invasive treatment option as a patient themselves, compared to what they choose for their patients. Source of Funding: - © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e949 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tarik Emre Sener More articles by this author Thomas Tailly More articles by this author Amelia Pietropaolo More articles by this author Etienne Xavier Keller More articles by this author Yiloren Tanidir More articles by this author Juan Gomez Rivas More articles by this author Zeeshan Hameed More articles by this author Vincent De Coninck More articles by this author Tzevat Tefik More articles by this author Kemal Sarica More articles by this author Ali Serdar Gozen More articles by this author Andreas Skolarikos More articles by this author Olivier Traxer More articles by this author Bhaskar Somani More articles by this author Expand All Advertisement PDF DownloadLoading ...

Unplanned Hospital Visit After Urinary Stone Procedure

Background: Urinary stone is a multifactorial disease which is common in daily urological practice, and is also a substantial public health problem. Surgical management of urinary calculi has changed enormously during the past 20 years. Nowadays, the trend among urologists involved in the management of patients with urinary tract stones is to choose the less invasive and more effective option. Objective: We evaluate the causes of the unplanned hospital visit following shock wave lithotripsy (ESWL), URS (Uretrorenoscope), and PCNL (percutaneous nephrolithotomy)surgical procedures for stone disease and determine the predictors affecting on the visit and readmission. Patients and Methods: This study is a cross-sectional study carried out in Ghazi Al-Hariri hospital for subspecialized surgery in Medical City Complex in Baghdad city-Iraq. The duration of the study was 18 months throughout the period from January, 2019 till June 2020. The majority of SWL techniques were as an outpatient procedure. The patients received analgesia and in each SWL session, 3000 shocks were delivered at a rate of 60 to 90 shocks/min. For URS the patients were performed under general or spinal anesthesia. In cases where ureteral access was not possible, insertion of a ureteric stent was the option followed by ureteroscopy after 14 days. In PCNL the surgical procedure was fluoroscopic guided , prone position used .This procedure was performed under general anesthesia. Results: A 362 patients with urinary stones; 41 unplanned visits were recorded within one month of surgical operation. The incidence of unplanned visits after management of urinary stone in Medical City Complex was (11.3%) and rate of unplanned visits according to management types( 26.6%, 18.8% and 4.6% for PNL, URS and ESWL) . Conclusion: The rate of unintended visits within 30 days after treatment of urinary tract was treated at Martyr Ghazi Hariri Specialized Surgery at the Medical City Complex in the world, and the rate of unplanned visits within 30 days after the removal of the kidneys The percutaneous route is the highest, followed by ureteroscopy and the lowest level after extracorporeal lithotripsy.Factors influenced by unintended visits such as hospital exit, and not given cafés after exit, insufficient follow-up and therapeutic mistakes that are still large. Reservation therapy is the perfect treatment method for treating illegal visits special after the ureter end. Keywords:Shock wave lithotripsy, percutaneous nephrolithotomy, Uretrorenoscope

Plants Used in Mexican Traditional Medicine for the Management of Urolithiasis: A Review of Preclinical Evidence, Bioactive Compounds, and Molecular Mechanisms.

Urolithiasis (UL) involves the formation of stones in different parts of the urinary tract. UL is a health problem, and its prevalence has increased considerably in developing countries. Several regions use plants in traditional medicine as an alternative in the treatment or prevention of UL. Mexico has known about the role of traditional medicine in the management of urinary stones. Mexican traditional medicine uses plants such as Argemone mexicana L., Berberis trifoliata Hartw. ex Lindl., Costus mexicanus Liebm, Chenopodium album L., Ammi visnaga (L.) Lam., Eysenhardtia polystachya (Ortega) Sarg., Selaginella lepidophylla (Hook. & Grev.) Spring, and Taraxacum officinale L. These plants contain different bioactive compounds, including polyphenols, flavonoids, phytosterols, saponins, furanochromones, alkaloids, and terpenoids, which could be effective in preventing the process of stone formation. Evidence suggests that their beneficial effects might be associated with litholytic, antispasmodic, and diuretic activities, as well as an inhibitory effect on crystallization, nucleation, and aggregation of crystals. The molecular mechanisms involving these effects could be related to antioxidant, anti-inflammatory, and antimicrobial properties. Thus, the review aims to summarize the preclinical evidence, bioactive compounds, and molecular mechanisms of the plants used in Mexican traditional medicine for the management of UL.

A0247 - Worldwide survey on the current practice of asymptomatic urinary stone management: A survey from EAU, Young Academic Urologists (YAU), Endourology and Urolithiasis Working Party

A0247 - Worldwide survey on the current practice of asymptomatic urinary stone management: A survey from EAU, Young Academic Urologists (YAU), Endourology and Urolithiasis Working Party

A Critical Review on Antiurolithiatic Activity of Bioactive Phytoconstituents

New drugs are introduced in the market every year and new diseases are emerging every year and there is no cure for existing diseases. Though new drugs are being approved by the FDA every year, controlling emerging infections is a global concern. Due to increased side effects and toxicity the modern world is turning towards herbal medicine. Due to few reasons like global warming, food habits and modern life style disease like Urolithiasis places a significant economic burden on the healthcare system, especially in developed and developing countries where, owing to changes in food habits and lifestyle, the prevalence of stone disease has significantly increased over the last few decades; unfortunately, it will probably continue to increase for a number of reasons. Despite considerable improvements in the development of new herbal therapies for the management of urinary stones, the incidence of urolithiasis is increasing worldwide. However, it is evident that crystal retention, cell apoptosis, renal cell injury, and associated stone promoters or inhibitors play important roles for kidney stone formation. In addition, the identification of novel phytoconstituents on the basis of molecular and cellular alterations in relation to stone formation will help develop better herbal remedies. Moreover, better understanding of the mechanisms of urolithiasis associated with stone inhibitors or promoters will be critical for stone-removing medications. This review encompasses different medicinal plants, polyherbal formulations and phytoconstituents used in the treatment of Kidney stones. More interdisciplinary research is needed to develop new plant-derived high-quality natural products to treat and prevent the formation of kidney stones.

Prevention and management of urinary stone

The prevalence of urolithiasis is increasing not only in South Korea but also around the world. Urolithiasis has a high recurrence rate, therefore, reducing it is very important in the quality of life for stone formers. For this purpose, dietary modifications and drug therapy can be performed through stone analysis and 24-hour urine collection. Stone analysis is recommended for all stone formers, and the 24-hour urine collection is usually recommended for recurrent stone formers or high-risk groups. A general dietary modification for all stone formers includes a sufficient fluid intake, low levels of sodium, sugar, and animal protein, a normal calcium diet, as well as a high amount of citrate intake. Drug therapy should be performed in cases such as the recurrence of stones or increase of the existing ones, even after the application of preservation therapy, such as dietary modification. The ideal drug therapy should prevent the occurrence of urolithiasis, have no side effects, and have a suitable patientsʼ compliance. Follow-up should be performed periodically, through 24-hour urine collections and imaging studies. For follow-up imaging studies, a lowdose non-enhanced computed tomography is recommended, and it can be performed once a year if the patient is in a stable state. To control various and complex metabolic abnormalities in recurrent stone formers, multiple approaches may be required through diet modifications, drug therapy, treatment of the metabolic syndrome, and lifestyle modifications.

Surgical management of urinary stone

Urolithiasis is a common urological disease that causes a significant deterioration in patients’ life quality due to severe pain and frequent recurrence. With increases in the incidence of urolithiasis, different treatment methods have been developed. Although urolithiasis is still managed in Korea with extracorporeal shock wave lithotripsy, the development of minimally invasive techniques and endoscopy instruments has led to increased surgery. Prior to the introduction of endoscopy, urolithiasis surgery was performed as open procedures such as ureterolithotomy, pyelolithotomy, and nephrolithotomy. However, most recent stone surgeries are performed using endoscopy with comparable outcomes and fewer complications. Laparoscopic or robot-assisted laparoscopic surgeries are performed in exceptional cases. Since urolithiasis can be found in various urinary organs, such as the kidney, ureter, bladder, and even the urethra, the approach, method, and availability of endoscopy will vary depending on the stoneʼs size and location. Understanding the types and characteristics of each surgical method will determine the appropriate procedure for each patient and improve the surgical outcomes.

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

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.