A prospective randomised double-blind placebo-controlled trial to assess the effect of diuretics on shockwave lithotripsy of calculi

Furosemide improves the stone clearance rate of extracorporeal shockwave lithotripsy for kidney stones but not ureteral stones: a systematic review and meta-analysis

Introduction

We conducted a meta-analysis (MA) to investigate the effects of furosemide on the prognosis of extracorporeal shockwave lithotripsy (SWL) therapy to remove renal (RS) and ureteric stones (US).

Methods

We screened scientific databases including PubMed, Clinicalkey, Google Scholar, Medline, Embase, and Cochrane, from the date of establishment until March 2022, to search for randomized controlled trials evaluating SWL, in combination with furosemide (experimental group) or with SWL alone (control group), in treating RS or US. Our search terms included furosemide, extracorporeal SWL, and urolithiasis. For this MA, we employed the Cochrane Collaboration's RevMan version 5.3.0.

Results

Six trials, involving 1344 participants, with RS (n = 1097) and/or US (n = 247), met our predefined criteria. This included 137 proximal ureteral stones (PUSs), 35 mid-ureteral stones (MUS), and 75 distal ureteral stones (DUS). In case of RS, the experimental group exhibited significantly enhanced clearance, relative to controls (risk ratio [RR] = 1.16, 95% confidence interval [CI] = 1.07-1.25, p = 0.0002), yet there was no obvious difference in the PUS, MUS, and DUS (RR = 1.14, 95% CI = 0.97-1.33, p = 0.10; odds ratio [OR] = 1.26, 95% CI = 1.40-3.95, p = 0.69; RR = 1.21, 95% CI = 0.99-1.49, p = 0.06). There was also no marked difference between fragmentations in either group. Only reports of SWL treatment of RS provided adequate data on shocks, sessions, and complications for our analysis. Unfortunately, there was no significant alteration between the two groups.

Conclusion

According to our analysis, furosemide strongly accelerates the clearance rate of SWL-treated RS. However, it does not enhance the fragmentation rate. Given this evidence, we propose that furosemide does not significantly improve the efficacy of SWL therapy in removing US.

Registration

Our work is registered with PROSPERO (CRD42020204780).

The efficacy and safety of diuretics on extracorporeal shockwave lithotripsy treatment of urolithiasis: A systematic review and meta analysis

BACKGROUND

The aim of this systematic review and meta-analysis was to demonstrate the efficacy and safety of diuretics on extracorporeal shockwave lithotripsy (SWL) treatment of urolithiasis.

METHODS

The databases MEDLINE, EMBASE, and the Cochrane Controlled Trial Register of Controlled Trials from January 1980 until November 2019 were searched to identify randomized controlled trials that referred to the use of diuretics on extracorporeal SWL treatment of urolithiasis.

RESULTS

Six randomized controlled trials containing 1344 patients were included in this meta-analysis, which compared diuretics with placebo on extracorporeal SWL treatment of urolithiasis. In the analysis, we found that diuretics on extracorporeal SWL treatment were more effective for the management of urinary stones. Compared with placebo, patients who received diuretics during extracorporeal SWL treatment had significantly higher successful stone clearance rate (Odds ratio; 1.73, 95% confidence interval (CI); 1.35 to 2.21, P < .0001), higher stone fragmentation rate (odds ratio; 2.83, 95% CI; 1.30 to 6.16, P = .009), less average number of sessions per stone (mean difference; -0.13; 95% CI, -0.25 to -0.01, P = .03) and similar average number of shocks per stone (mean difference; -126.89; 95% CI, -394.53 to 140.76, P = .35).

CONCLUSION

This systematic review and meta-analysis indicates that diuretics during extracorporeal SWL was effective in the management of urolithiasis with lower risk of complications.

Effects of diuretic administration on outcomes of extracorporeal shockwave lithotripsy: A systematic review and meta-analysis

The present systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted for investigating the effect of diuretics on the outcomes of shockwave lithotripsy (SWL) for the treatment of urinary stones. We performed searches of PubMed, Web of science, Embase, EBSCO, and Cochrane library databases from inception to November 2019. RCTs were selected for assessing the effects of diuretics on fragmentation and clearance of urinary stones. The search strategy and study selection process were performed in accordance with the PRISMA guidelines. Four RCTs were included in the meta-analysis. Overall, intervention groups experienced significant improvements in fragmentation compared with the control groups (risk ratio [RR] = 1.14, 95% confidence interval [CI] = 1.05–1.03, P = 0.02). However, stone clearance did not significantly differ between the intervention and control groups (RR = 1.23, 95% CI = 0.97–1.56, P = 0.08). The total numbers of shocks and sessions required were significantly reduced by the use of diuretics. Diuretics significantly enhance stone fragmentation for patients undergoing SWL. However, the improvement in stone clearance appears to be insignificant.

Efficacy of extracorporeal shockwave lithotripsy with furosemide and hydration in renal stone management: A randomised controlled trial

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.