Sohu S. et al., 2019: Efficacy of extracorporeal shockwave lithotripsy with furosemide and hydration in renal stone management: A randomised controlled trial
Sohu S, Soomro MH, Mangrio RH, Shaikh AA, Mirani A, Chand K, Jalbani MH.
Department of Urology, Chandka Medical College and Hospital, Shaheed Mohtarma Benazir Bhutto Medical University (SMBBMU), Larkana, Pakistan.
Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Saint-Antoine Medical School, Sorbonne Université and INSERM, Paris, France.
Department of Community Medicine, Al-Nafees Medical College and Hospital, Isra University-Islamabad Campus, Islamabad, Pakistan.
Department of Urology, Jinnah Sindh Medical University, Karachi, Pakistan.
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.
Arab J Urol. 2019 Jul 24;17(4):279-284. doi: 10.1080/2090598X.2019.1645262. eCollection 2019. FREE ARTICLE
Comments 1
The role of diuretics during SWL treatment has remained a matter of debate over time. In a randomized comparative study in my own department some years ago it was shown that a ureteral catheter and high diuresis did not improve stone-free rates in patients treated for ureteral stones. In contrast the clinical success with high fluid infusion during SWL of stones in the kidney is the reason why we routinely have continued with high pressure fluid infusion and furosemide.
This clinical routine is given substantial support by the results in this randomized study. The patients were randomized to hydration with or without administration of furosemide. In 275 (Group A) and 233 (group B) patients stone-free rates were 77% and 65%, respectively (p