Solitary Renal Stones Research Articles

Feasibility of Performing Supine Percutaneous Nephrolithotomy for Solitary Renal Pelvic Stones (1.5-3 cm) Under Spinal Anaesthesia: A Single-Centre Study.

Introduction Percutaneous nephrolithotomy (PCNL) procedure has evolved over the yearsand one such evolution has been the introduction of supine PCNL by Valdivia in 1987. This approach offers the added advantage of safe access in patients with compromised cardiovascular and pulmonary function. General anesthesia is the preferred anesthetic technique for PCNL. However, in the last decade, there has been an increase in the usage of regional anesthesia for this procedure. We share our experience of supine PCNL for solitary renal pelvic stones under regional anesthesia. Aim and objective To assess the feasibility, safety, and efficacy of supine PCNL for solitary renal pelvic stones sized1.5 to 3 cm under spinal anesthesia. Material and methods This was a retrospective record review of 35 patients (21 male) who underwent supine PCNL under regional anesthesia between January 2022 till December 2022 at our institute. All patients had asolitary renal pelvic calculus sized 1.5-3 cm. Intraoperative and postoperative data were analyzed. Results The mean age of patients was 38.5 ± 15 years. The postoperative pain visual analog scale (VAS) score was <5 in 31 (89%) and >5 in 4 (11%) patients. The mean hospital stay was 3.33 ± 0.88 days. Mean fall in hemoglobin level was 0.49 ± 0.43 mg/dL. Postoperatively, mild hematuria occurred in three patients (8.5%) and fever occurred in two (5.7%) patients. There was no injury to adjacent organs in this series. Blood transfusion was required only in one patient. Complete stone clearance was achieved in all patients. Conclusion In experienced hands, supine PCNL under regional anesthesia is a feasible, safe, and effective approach with minimal morbidity.

MANAGEMENT OF RENAL STONES WITH MINI PERC – AN INSTITUTIONAL EXPERIENCE

Standard PNL is known to have higher clearance rates for stones more than 2 cm sizes. However, it is not promoted because of its associated morbidity, especially bleeding in smaller and non-bulky urolithiasis. Miniaturization of the PNL has spawned a new interest in this modality for treating small bulk urolithiasis. We wanted to put forward our experience with mini pcnl in the management of 1-2cm solitary renal stones in western Rajasthan.

Evaluation of efficacy and outcome of retroperitoneal laparoscopic pyelolithotomy and open pyelolithotomy in patients with renal stones

Background: Urolithiasis has affected humans since antiquity. The aim of the study was to evaluate the efficacy and outcome of retroperitoneal laproscopic pyelolithotomy and open pyelolithotomy in patients with renal stones.Methods: The present prospective randomized clinical study was carried out in department of surgery from June 2017 to April 2021 in patients with renal stones. A total of 100 patients with solitary renal pelvic stone were properly assessed radiologically and clinically before planning the surgical intervention.Results: The overall mean age of presentation among patients undergoing pyelolithotomy was 41.9±12.30 years (χ2=5.14, p≤0.001). Minimum number of patients were 41-60 years age group i.e.; 58 patients. 70 patients were males while 30 patients were females with male to female ratio 2.33:1. The mean stone size among patients undergoing LP and OP was 1.9±0.5 cm. The mean operative time (min) among patients undergoing LP group (123.9±9.5 minutes) was more as compared to OP group was 80.1±17.5 min. The mean duration of return to work was 3.86±1.39 days. The mean duration of return to work in LP group was 3.87±1.37 days, while in OP group was 5.87±1.34 days (χ2=18.56, p&lt;0.02).Conclusions: Retroperitoneal laproscopic pyelolithotomy proved to be safer in all the aspects than open pyelolithotomy.

The Efficiency of Moses Technology Holmium Laser for Treating Renal Stones During Flexible Ureteroscopy: Relationship Between Stone Volume, Time, and Energy.

Introduction: There are limited data on how stone factors relate to flexible ureteroscopy (f-URS) laser lithotripsy efficiency and outcomes when using the Moses Technology Ho:YAG system. We examined the relationship of stone volume and density to lithotripsy, lasing times, and energy used to treat a single renal stone. We also assessed short-term clinical outcomes. Methods: We analyzed patients undergoing f-URS by a single surgeon using high-power Moses Technology Ho:YAG system (Lumenis). We only included cases with a CT confirming a solitary renal stone. Ureteral stones, staged and bilateral procedures were excluded. Stone dimensions and HU were obtained. Volume (mm3) was calculated using European Association of Urology criteria. Laser energy (J), lithotripsy, and lasing times were obtained. Laser activity was calculated by dividing lasing time by lithotripsy time. Relationships between time, stone density, volume, and energy were assessed using Spearman correlation. Complications were assessed using Clavien-Dindo grade. Residual fragments (RF) were determined on imaging within 3 months. Results: Twenty-nine patients met the inclusion criteria. Mean (range) stone volume and density were 290 mm3 (42-1700) and 814 HU (170-1675), respectively. Mean lithotripsy and lasing times were 11.9 (3.6-26.0) and 6.0 (0.6-19.6) minutes, respectively. Mean laser activity was 47%. Mean fragmentation speed was 0.9 mm3/s. Mean energy used per unit stone volume was 38.2 J/mm3. Time taken to perform fragmentation had a stronger association with the stone volume vs stone density. Three (10.3%) and 2 (6.9%) patients had a Clavien Grade 1 and 2 complications, respectively. At follow-up the zero-fragment rate was 79.3%. Conclusions: When using the Moses Technology laser to ablate a single renal stone with f-URS, the fragmentation speed was ∼1 mm3/s. Stone volume, not density was correlated to lasing time. We propose mm3/s be considered a measure that has implications for technique efficiency and comparing laser platforms.

Outcomes of flexible uretrorenoscopy for solitary renal stones up to 15 mm, hits and misses: A single-surgeon experience.

:Introduction: In this study, we retrospectively evaluated the outcomes of flexible uretrorenoscopy (fURS) for removal of solitary renal stones sized up to 15 mm.Material and Methods:We evaluated the data of 115 patients who underwent fURS at our unit between Jan 2018 and Dec 2019. All fURS were performed by a single surgeon using Flex-2 flexiscope. Ureteral Access sheath (UAS) of size 9/11 fr was used in all patients. Stones were fragmented using 20 watts laser. Few fragments were retrieved using Nitinol zero tip basket for assessment of the passability of remaining dust and sent for stone analysis. Data pertaining to demographic characteristics, stone size, stone site, operative time, intra and post operative complications were retrieved from the records.Results:Of the 115 patients who underwent fURS, 71 (61.7%) were male and 44 (38.2%) were female. Average age of patients was 32.9±8.9 years; the average body mass index was 22.9±3.9 kg/m2. Average size of the stone was 11.0±1.5 × 10.2±1.3 mm. The stone free rates at the end of 3 weeks and 3 months were 97% and 99%, respectively.Conclusion:fURS is an effective minimally-invasive procedure for removal of single stones up to 15 mm in size. We observed minimal morbidity rates and acceptable stone free rates in our series.

A comparative study of minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery for solitary renal stone of 1-2 cm.

Background:PCNL is the treatment of choice for renal stones. But wide array of complications due to larger tract size(>20 Fr) has lead to development of improved techniques like miniPCNL(<20 Fr) and RIRS(Retrograde intrarenal surgery).Aim and Objective:To perform a study comparing miniPCNL with RIRS for renal stones 1-2 cm with respect to stone free rate , complications and quality of life.Materials and Methods:A prospective, randomised study was carried out our tertiary care centre, recruiting 40 patients in each group from Dec 2016 to Oct 2018. Patients demographic characteristics, operative findings, surgical outcomes and quality of life( SF-36 questionnaire) were recorded with 3 months of follow-up.Results:RIRS has longer operative time (69.75 min > 51.58 min; p=0.003), lesser radiation exposure (p=0.012), shorter hospital stay (p =0.15), lesser blood loss and lesser post operative pain on POD1 and POD2 (p =0.005, p=0.001 respectively). RIRS group patients sufferred more post op complications (p=0.03 )of which urosepsis was most common. Stone free rate is significantly better(p =0.003) in miniPCNL group on POD1 , while SFR's at 1 month (miniPCNL-90% and RIRS -85%) and 3 month (miniPCNL- 92.5% and RIRS -87.5%) was better in miniPCNL group, but statistically insignificant.On subgroup analysis SFR in lower pole calculus was better in miniPCNL group at 1month and 3 month (p=0.008). Second intervention for stone clearance was required in 3 patients of miniPCNL and 5 patients of RIRS, out of which 4 had lower pole stone.No significant differnce was found in quality of life in both groups at 1 month.Conclusion:MiniPCNL is a better treatment modality for higher single step stone free rate, shorter operative time and fewer postop complication. RIRS has SFR slightly less than miniPCNL but has less radiation exposure and much less post operative pain. There is no significant difference in quality of life in both groups.

A Retrospective Observational Study for Prediction of Stone-Free Status after Single-session of Retrograde Intrarenal Surgery for Renal Stones

Introduction: Retrograde Intrarenal Surgery (RIRS) is a preferred minimal invasive treatment modality for renal stones with advantages of being effective and having lower morbidity rates. Aim: To predict the Stone Free Rate (SFR) after RIRS with lower pole and non-lower pole stones. Materials and Methods: The records of 85 consecutive patients who underwent unilateral RIRS from September 2016 to July 2019 were retrospectively analysed. The studied parameters included patient demographics, stone characteristics (size, volume, and attenuation, Lower Pole Infundibulopelvic Angle (LP IPA) and operative time, presence of preoperative Double-J Stent (DJS) and Stone Free Status (SFS). Standard statistical tests were applied with level of significance as p&lt;0.05. Results: Overall success rate was 83.5% (71 cases) while 14 cases had Residual Stones (RS) at 1 month. The mean age of the patients was 41.07±12.25 years. The mean operative time was 68.85±22.3 minutes. Mean stone size and stone volume were higher in the RS group compared to SF (Stone free) group, 15.07±1.5 mm vs. 12.28±1.6 mm, 1187±145 mm3 vs.680.67±289 mm3 respectively (p&lt;0.001; p&lt;0.001). In RS group, 90% (13) cases had IPA&lt;45°, while 80% cases with IPA&gt;45° were stone free. Patients with non-lower pole stones has SFR 2.8 times compared to LP stones (p&lt;0.001). On multivariate analysis, only LP IPA and LP stone location predicts SFS after RIRS. Conclusion: RIRS is effective procedure for renal stones. Stone size, stone volume, LP stone location and LP IPA effectively predict SFR. However, LP IPA and LP stone location are the most significant predictor of SFS, after single session RIRS for solitary renal stone.

Comparing 60 versus 120 shocks per minute for shock-wave lithotripsy of solitary renal calculi: A controlled randomized study

Objective: This study aimed to compare the difference in outcome of shock-wave lithotripsy (SWL) using a slow rate of 60 shocks per minute versus a rapid rate of 120 shocks per minute generated by an electromagnetic lithotripter for renal calculi. Methods: From May 2017 to June 2019, 156 patients ( Mage=38.7 years) with single radio-opaque renal stones smaller than 20 mm were included and randomly divided into two groups: group A, 78 patients who received 60 shocks per minute; and group B, 78 patients who received 120 shocks per minute. Patients were radiologically reviewed at 3 months for an outcome. Results: There was no statistically significant difference between mean stone area treated ( p=0.222) or additional analgesic use in the form of patient-controlled analgesia (PCA; alfentanil; p=0.82). A successful outcome was defined by fragments smaller than 4 mm or stone-free status. In group A, 60% of patients had a successful outcome compared with 61.4% in group B ( p=0.869) following a single treatment. Post-treatment complications were similar in both groups at 12% for group A and 10.7% for group B ( p=0.797). Conclusions: There was no statistically significant difference between the delivery of 60 and 120 shocks per minute during SWL for the treatment of solitary renal stones with a mean stone area of 62 mm2 regarding the outcome, complications or PCA use when using a Dornier Compact Delta II lithotripter.

Prospective Randomized Study of Fixed Laser Setting Verses Variable Laser Settings for a Better Stone Free Rate

OBJECTIVE: To assess the outcome of variable laser settings verses fixed setting on the stone free rate and complications. MATERIAL AND METHOD: We conducted a prospective, single-blind randomized controlled study. Solitary renal non lower pole stones 10 to 20 cm were included. A total of 113 Patients were randomly divided in to two groups. In group A, fixed laser setting was used at 1.0J energy and 12Hz frequency during the entire procedure. In Group B, variable laser settings were used; initial fine fragmentation was performed @ 1.0J X 12Hz. Once the residual stone reduced enough to wobble, the energy was reduced to 0.8 J and 8Hz. Settings were further reduced to 0.5J and 5Hz as required to complete the fragmentation process with minimal migration. RESULT: Group A had 58 patients and Group B 55 patients for analysis of perioperative variables. Stone free rate (<2mm) is in favor of systematic stone dusting with variable frequency (95.8% vs 83.6%, p=0.05). Post-operative fever and pain were not statistically significant between the groups (fever 10.3% vs 9.1%, p=1.00) (pain mean VAS 1/10 in group A vs 2/10 in group B). CONCLUSION: The solitary hard stones of 10 to 20 mm can be treated with more than 95% SFR using variable laser settings producing fine dust, without increase in significant postoperative complications or hospital stay.

Comparing micro-percutaneous nephrolithotomy and retrograde intrarenal surgery in treating 1-2cm solitary renal stones in pediatric patients aged less than 3 years

Comparing micro-percutaneous nephrolithotomy and retrograde intrarenal surgery in treating 1-2cm solitary renal stones in pediatric patients aged less than 3 years

Punctures versus shocks: a comparison of renal functional and structural changes after percutaneous nephrolithotomy and shockwave lithotripsy for solitary renal stone

Objective: To evaluate renal functional and structural changes following percutaneous nephrolithotomy and shockwave lithotripsy for solitary non-obstructing non-staghorn renal stone. Materials and methods: Patients with solitary unilateral non-staghorn renal stones who were planned for percutaneous nephrolithotomy (20 patients) and shockwave lithotripsy (20 patients) were prospectively evaluated for renal functional and structural changes 60 days after the procedure and complete clearance of stones. Tc99-dimercaptosuccinic acid was used to assess cortical scarring and Tc99-diethylenetriamine pentaacetic acid and Tc99-levo levo ethylecysteine were used for glomerular filtration rate calculations, respectively. Results: The mean stone size was 24.4 mm and 13.7 mm in the percutaneous nephrolithotomy group and the shockwave lithotripsy group, respectively. No new cortical scars developed in either of the groups on Tc99-dimercaptosuccinic acid scan. Both the treated and untreated kidneys showed an overall insignificant fall in glomerular filtration rate in both the groups. The number of patients showing significant deterioration in the individual glomerular filtration rate in both the treated and untreated renal unit was more in the shockwave lithotripsy group. Conclusion: Both percutaneous nephrolithotomy and shockwave lithotripsy are comparable in terms of adverse effects on renal parenchyma and renal function. Level of evidence: Not applicable for this multicentre audit.

Comparing micropercutaneous nephrolithotomy and retrograde intrarenal surgery in treating 1–2 cm solitary renal stones in pediatric patients younger than 3 years

To compare the effects of micropercutaneous nephrolithotomy (micro-PCNL) and retrograde intrarenal surgery (RIRS) in treating 1-2cm solitary renal stones in pediatric patients aged less than 3 years. A retrospective analysis was performed on data from 57 children younger than 3 yearswho received micro-PCNL and RIRS surgery in the authors hospital from October 2016 to August 2018. The patients were divided into group 1, the micro-PCNL group, and group 2, the RIRS group. Peri-operative data including surgical time, number of anesthesia sessions, stone-free rate (SFR), and complications were analyzed. There were 27 patients in group 1 and 30 patients in group 2, and the patients' mean ages were 19±9.9 months and 21±7.8 months, respectively (P=0.462). The stone size was 1.6±0.3cm in group 1 and 1.7±0.2cm in group 2 (P=0.217); the mean surgical time was 52±7min in group 1 and 48±9min in group 2 (P=0.163), and the mean lithotripsy time was 21±4min in group 1 and 23±5min in group 2 (P=0.148); and the SFR at 1 month after surgery was 88.9% in group 1 and 86.7% in group 2 (P=0.799). The number of anesthesia sessions for patients was 1.4±0.5 in group 1 and 2.7±0.5 in group 2 (P<0.001). The complication rate was 14.8% and 16.7% in group 1 and group 2, respectively (P=0.714). None of the patients needed conversion to the 12-14F mini-PCNL. The results of this study showed that the surgical effects and complications from micro-PCNL and RIRS in treating young children with 1-2cm solitary renal stones were similar. However, micro-PCNL reduced the need to prestent before surgery and allowed lower anesthesia sessions. Therefore, micro-PCNL is an effective alternative method for 1-2cm solitary renal stones in patients below 3 years of age.

440 - Comparing micro-percutaneous nephrolithotomy and flexible ureteroscopic lithotripsy in treating 1-2 cm solitary renal stones in infants

440 - Comparing micro-percutaneous nephrolithotomy and flexible ureteroscopic lithotripsy in treating 1-2 cm solitary renal stones in infants

Evaluation of laparoscopic retroperitoneal approach for management of various renal calculi

Background: Despite the availability of Multimodality treatment for management of renal calculi as ESWL (Extra Corporeal Shock Wave Lithotripsy), PCNL (Percutaneous nephrolithotomy), URS (Ureterorenoscopy), RIRS (Retrograde intrarenal surgery) and open surgery and Percutaneous nephrolithotomy (PCNL), the gold standard, laparoscopic pyelolithotomy is an alternative treatment modality as long as the operator has adequate laparoscopic experience. Evaluation of Laparoscopic retroperitoneal approach for management of various renal calculi must be done to get the efficacy of the procedure according to the calculus and renal morphology.Methods: Laparoscopic retroperitoneal pyelolithotomy/nephrolithotomy was performed on 58 patients with various renal calculi patterns viz. solitary pelvic calculus, staghorn calculus, staghorn calculus with calyceal and isolated calyceal calculi. Extended pyelolithotomy, Gilvernet’s technique were used as per the need.Results: Out of the 58 cases with renal calculi, solitary renal pelvic stones (n=23; 39.7%) were most common followed by staghorn (n=11; 19% Mean size 4.40±1.17 cm) and isolated caliceal stones (n=9; 15.5% with Mean size2.21±0.25 cm) respectively. There were 15 (25.9%) cases with mixed stones (11 cases solitary renal pelvic and isolated caliceal stones and 4 cases had staghorn and isolated caliceal stones). Stone clearance was 93.3 to 100%.Conclusions: laparoscopic retroperitoneal approach is a useful modality for clearance of renal calculi of different types with minimum complications and a high success rate. However, the technique seems to have a limited role for isolated caliceal stones where direct or C-arm guided nephrolithotomy can be performed for better clearance of stones.

Role of computed tomography morphodensitometry in predicting the outcome of shock wave lithotripsy

Objectives: The objective of this study was to predict the outcome of shock wave lithotripsy (SWL) on the basis of computed tomography (CT) morphodensitometry for ureteral and renal stones. We also assessed the possibility that Hounsfield unit (HU) values and the location of the stones could be used to predict the outcome of SWL. Material and methods: A prospective study was performed to measure stone size, location, composition, surface area, surface volume, stone burden, the skin-to-stone distance and the HU for solitary renal and ureteral stones by non-contrast CT studies (NCCT) from August 2013 to September 2015. Success of SWL was defined as: (1) being stone-free or (2) residual stone fragments &lt; 4 mm by radiography/NCCT. Results: Of the 100 assessed patients, 68 patients (68%) were stone-free, 12 (12%) had residual stone fragments &lt; 4 mm (clinically insignificant residual fragments) and 20 (20%) had residual stone fragments ≥ 4 mm/ancillary procedures. Multivariate analysis revealed that stone location and mean HU were significant predictors of SWL success. Receiver operating characteristic curves defined cut-off values for predicting treatment outcome. Treatment success rates were significantly higher for stones &lt; 800 HU than with stones &gt; 800 HU ( p = 0.160). Conclusion: Evaluation of stone HU values and stone location prior to SWL can predict treatment outcome and aid in the development of treatment strategies. Level of evidence 2 &amp; 4

Retroperitoneal laparoscopic pyelolithotomy in renal pelvic stone versus open surgery - a comparative study.

BackgroundThe introduction of endourological procedures such as percutaneous nephrolithotomy and ureterorenoscopy have led to a revolution in the the management of urinary stone disease. The indications for open stone surgery have been narrowed significantly, making it a second- or third-line treatment option.Aims and ObjectivesTo study the safety and efficacy of retroperitoneal laparoscopic pyelolithotomy in retroperitoneal renal stone. We compared the results of laparoscopic and open surgery in terms of easy accessibility, operative period, renal injuries, and early recovery.MethodsThis prospective study was conducted on renal pelvic stone cases from January 2009 to February 2016 in Suchkhand Hospital, Agra, India. The study included a total of 1700 cases with the diagnosis of solitary renal pelvic stones. In group A - 850 cases - retroperitoneal laparoscopic pyelolithotomy was performed, while group B - 850 cases – underwent open pyelolithotomy.ResultsThe mean operative time was less in group B than group A (74.83 min vs. 94.43 min) which was significant (p<0.001). The blood loss was less in the laparoscopic group than in the open group (63 mL vs. 103mL). There were statistically significant differences in the post-operative pain scores, and postoperative complications compared to group B (p<0.001). The mean hospital stay was less in group A (p<0.03), which was significant.ConclusionLaparoscopic surgery reduces analgesic requirements, hospital stay, and blood loss. The disadvantages include the reduced working space, the cost of equipment and the availability of a trained surgeon.

98 - Standard versus minimally invasive percutaneous nephrolithotomy in the management of solitary renal stones 20-30 mm

98 - Standard versus minimally invasive percutaneous nephrolithotomy in the management of solitary renal stones 20-30 mm

Urinary tract stone development in patients with myelodysplasia subjected to augmentation cystoplasty.

Patients with myelodysplasia who have undergone augmentation cystoplasty are at risk for urinary tract stones. We sought to determine the incidence and risk factors for stone development in this population. The charts of 40 patients with myelodysplasia who have undergone augmentation cystoplasty were reviewed. None had a prior history of urinary tract stones. All patients were seen on an annual basis with plain abdominal imaging, renal ultrasonography, and laboratory testing. Statistical analysis included a multivariable bootstrap resampling method and Student's t-test. Fifteen (37.5%) patients developed stones, 14 with bladder stones and 1 with a solitary renal stone, at a mean of 26.9 months after augmentation. Five (33.3%) developed recurrent bladder stones. The patient with a renal stone never developed a bladder stone. The mean follow-up for the stone formers was 117.2 months and for non-stone formers was 89.9 months. The stone incidence per year was 6.8%. Risk factors included a decline in serum chloride after augmentation (P = .02), female sex, younger age at time of augmentation, longer time period since augmentation, and bowel continence. A significant proportion of patients with myelodysplasia subjected to augmentation cystoplasty develop urinary tract stones, predominantly in the bladder. Dehydration may play a role in development of lower urinary tract stones as the decline in serum chloride suggests contraction alkalosis, which could lead to constipation and improved bowel continence. Therefore, improved hydration should be a goal in this cohort.

Laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for treatment of large renal pelvic calculi (diameter >2 cm): a meta-analysis

Objective: To systematically assess the efficacy and safety of laparoscopic pyelolithotomy (LP) versus percutaneous nephrolithotomy (PCNL) for the treatment of renal pelvic calculi >2 cm.Methods: We searched PubMed, Embase, Cochrane Library, and Google Scholar about LP and PCNL for the treatment of renal stones. The retrieval time ended in September 2015. Two reviewers independently assessed the quality of all included studies. The available data in the studies were analyzed using the RevMan 5.2 software.Results: Four randomized controlled trials (RCTs) and nine Non-Randomized Concurrent Controlled Trials (NRCCTs) were included, involving a total of 766 patients. This meta-analysis showed that LP has a statistically higher stone-free rate than PCNL [I2 = 0, OR = 0.26 (95% CI 0.10–0.64), p = 0.003], lower drop in hemoglobin level [I2 = 0, difference in mean drop = −0.83 (95% CI −1.05 to −0.61), p < 0.00001] and lower postoperation fever [I2 = 0, OR = 0.36 (95% CI 0.14–0.89), p = 0.03], and PCNL is associated with a lower length of hospital stay [I2 = 74%, difference in mean of hospital stay = 0.72 (95% CI 0.04–1.40), p = 0.04].Conclusion: LP is an alternative for the treatment of large solitary renal stone. LP may have a higher stone-free rate, lesser blood loss, lower postoperation fever rate, while PCNL may have a lower length of hospital stay. However, further well designed and large volume randomized controlled trials are needed to confirm these findings.

Role of Tamsulosin Therapy after Extracorporeal Shockwave Lithotripsy for Renal Stones: Randomized Controlled Trial

Introduction: To evaluate the efficacy of adjunctive tamsulosin therapy after extracorporeal shockwave lithotripsy (SWL) for renal stones. Materials and Methods: This prospective study was conducted on patients who underwent single-session SWL for solitary renal stone less than 20 mm. Post-SWL, patients were randomly divided into 2 groups; the tamsulosin group (TG), received a daily dose of tamsulosin 0.4 mg, for a maximum of 12 weeks, with post-SWL traditional analgesia and control group (CG), received the traditional analgesia alone. Results: The study enrolled 271 patients and eventually only 249 (123 in TG and 126 in CG) completed the study. The overall stone free rate was 73.5%: 78.0% in TG and 69.0% in CG (p = 0.108). In TG, 8.1% of patients experienced at least one episode of acute renal/ureteral colic compared with 19.8% of controls (p = 0.008). The mean cumulative analgesia dosage per subject was 313 mg in TG and 346 mg in CG (p < 0.001). Overall, 14 patients developed steinstrasse and 6 of them (all in CG) needed urgent intervention (p = 0.031). Conclusions: Daily tamsulosin therapy does not enhance the clearance of stone fragments but decreases the pain episodes, analgesia dosage and need for adjuvant intervention after SWL for renal stones.