Sabharwal S et al, 2017: A prospective randomised double-blind placebo-controlled trial to assess the effect of diuretics on shockwave lithotripsy of calculi.
Sabharwal S, Jeyaseelan L, Panda A, Gnanaraj L, Kekre NS, Devasia A.
Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India.
Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India.
Abstract
Objective: To assess the effect of diuretics with shockwave lithotripsy (SWL) on the treatment of renal and upper ureteric calculi.
Patients and methods: Adult patients with a solitary non-obstructive radio-opaque renal or upper ureteric calculus with normal renal function were included. They were prospectively randomised to receive either SWL with placebo or SWL with diuretics (40 mg parenteral furosemide) in a double-blind manner with a sample size of 48 patients in each arm. The primary outcomes were the SWL success and failure rates. The secondary outcomes were the number of shocks and sessions.
Results: Complete fragmentation was achieved in 89.6% of the patients in the furosemide arm as compared to 81.3% in the placebo arm. Clearance was achieved in 77.1% of the patients in the furosemide arm as compared to 70.8% in the placebo arm. The number of shocks and the number of sessions were higher in the placebo arm. These differences were not statistically significant. Conclusion: The use of diuretics along with SWL treatment of renal and upper ureteric calculi does not show a statistically significant improvement in fragmentation or clearance.
Arab J Urol. 2017 Jul 8;15(4):289-293. doi: 10.1016/j.aju.2017.04.003. eCollection 2017 Dec. FREE ARTICLE
Comments 1
This is an interesting study dealing with the possible role of diuretics for improved stone disintegration. The majority of stones in the study were located in the ureter.
Furosemide or placebo were administered at the beginning of the treatment. There was, however, no information on simultaneous administration of fluids and nothing is known about the diuresis during the SWL procedure. It is slightly surprising that the 24h urine volume was almost identical in the two groups.
Recording of disintegration and fragment/stone clearance are excellent output variables, whereas the number of shocks is a too subjective estimate.
Although a statistical difference between the two treatment methods were not obtained, the observations are of some interest and the study was probably underpowered. Additional studies of this kind might be of value.