Effectiveness of combined therapy in urolithiasis

Abstract

ABSTRACT.

Introduction. Urinary lithiasis is an important health issue, with an estimated prevalence of 2-3% in the general population and about 70% of recurrence rate.

The objective of the study. To evaluate the efficacy of combined medication (potassium and magnesium tribasic citrate and pyridoxine) versus traditional general recommendations, in removing the remaining stone fragments after extracorporeal shock wave lithotripsy, ureteroscopy and percutaneous nephrolithotomy.

Material and methods. The study enrolled 60 patients after kidney or ureteral stones treatment performed by extracorporeal shock wave lithotripsy (ESWL), with signs of calculus disintegration, ureteroscopy (URS) with contact lithotripsy, and after percutaneous nephrolithotomy (PNL). The patients were randomly divided into 2 groups. Patients from Group I (n=30) were administered potassium citrate tribasic 2.7 gr, magnesium citrate tribasic 376 mg, pyridoxine 25 mg in sachet, twice daily for two months. The control group (Group II), initially consisting of 30 patients, was prescribed only general recommendations.

Results. The increase in daily diuresis was statistically significant compared to the control group (2275±257 mL vs 1580 ± 321 mL, p <0.05). The urine pH in the study group was statistically significant higher (7.1±0.3) compared to the control group (6.2±0.9), p <0.01. The renal colic during the expulsion period of disintegrated calculus fragments was present in 1.8±0.3 cases (study group) compared with 6.7±0.8 (control group), p> 0.001. The „stone-free“ rate was the basic index of the study. The rate of spontaneous removal of disintegrated stone fragments was 90.0% in the study group compared with 71.4% in the control group (p <0.05). The visual analogue scale (VAS) score was 4 points in the study group and 7 points in the control group.

Conclusions. The addition of combined therapy in the postoperative treatment of urinary calculi reduces the expulsion time of disintegrated calculus fragments, the number of attacks of renal colic and possibly the need for analgesic administration.