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Optimal non-invasive treatment of 1–2.5 cm radiolucent renal stones: oral dissolution therapy, shock wave lithotripsy or combined treatment—a randomized controlled trial

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Abstract

Purpose

To evaluate the efficacy of oral dissolution therapy (ODT), shock wave lithotripsy (SWL), and combined SWL and ODT for medium-sized radiolucent renal stone (RLS).

Methods

A randomized controlled trial for patients with medium-sized RLS, 1–2.5 cm, ≤ 500 Hounsfield unit (HU). The ODT patients were counseled for oral potassiumsodium-hydrogen citrate (Uralyt-U®). The 2nd group underwent SWL and the last group had combined SWL and ODT. The primary outcome, stone-free rate (SFR) at 3 months, was assessed by non-contrast computed tomography (NCCT). We defined complete response (success) if no residual fragment were detected by NCCT; partial response (failure) if there was a decrease in stone size, but presence of residual stones; no response if there was no change or increase in stone size (failure).

Results

150 patients completed follow-up. The SFR at 1st month and 3rd month were, respectively; 16% and 50% in the ODT group, 10% and 46% in the SWL group, and 35% and 72% patients in combined group with (p = 0.03 and 0.003, respectively. The overall SFR for all groups was 66%. Combined treatment and initial response in first month follow-up were independent factors predicting SFR. In addition, combined treatment significantly decreased the overall stone volume (p = 0.03) and the need for additional stone management procedures after 3 months (p = 0.01).

Conclusion

Combined ODT and SWL treatment constitutes the most rapid and effective therapeutic approach for medium-sized RLS, decreasing overall stone volume as well as the number of SWL sessions needed in comparison to SWL therapy, alone.

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Author notes

    Authors and Affiliations

    1. Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt

      Mohammed A. Elbaset, Abdelwahab Hashem, Ahmed El-Assmy, Khaled Z. Sheir & Ahmed A. Shokeir

    2. Urology Department, Mediclin Muritz Hospital, Waren, Germany

      Ahmed Eraky

    3. Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt

      Mohammed A. Badawy

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    1. Mohammed A. Elbaset
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    2. Abdelwahab Hashem
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    3. Ahmed Eraky
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    4. Mohammed A. Badawy
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    5. Ahmed El-Assmy
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    6. Khaled Z. Sheir
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    7. Ahmed A. Shokeir
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    Contributions

    Elbaset MA: Patients’ follow-up and data collection, Hashem A: manuscript writing and editing. Eraky A: study design revision, Badawy M: Radiology supervision, El-Assmy: study supervision, Sheir KZ: study supervision and statistical analysis, Shokeir AA: study supervision.

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    Correspondence to Abdelwahab Hashem.

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    All procedures in this study involving human participants were in accordance with the 1964 Helsinki Declaration and its later amendments.

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    Informed consent was obtained from all individual participants in this study.

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    Khaled Z. Sheir and Ahmed A. Shokeir are equal last author.

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    Elbaset, M.A., Hashem, A., Eraky, A. et al. Optimal non-invasive treatment of 1–2.5 cm radiolucent renal stones: oral dissolution therapy, shock wave lithotripsy or combined treatment—a randomized controlled trial. World J Urol 38, 207–212 (2020). https://doi.org/10.1007/s00345-019-02746-2

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    • DOI: https://doi.org/10.1007/s00345-019-02746-2

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