The use of progesterone for ureteral stones: a preliminary report

Medical Therapy of Urolithiasis

Nephrolithiasis treatment has become easier and less invasive with the development of extracorporeal shockwave lithotripsy (SWL) and endourologic techniques. However, medical therapy represents a well-established and complementary approach that can improve the efficacy of SWL and endourology. During recent decades, pharmacologic intervention has become more effective in stone disease: drugs can control the pain of renal colic, interfere at various levels in lithogenesis, and contribute to the expulsion of stones. It is well known that lithogenesis is a multifactorial process influenced by environmental-nutritional factors (low urinary volume, diet rich in animal protein, etc) and metabolic alterations; i.e., hypercalciuria, hyperuricosuria, and deficiency of stone-inhibiting factors (citrate, magnesium, glycosaminoglycans [GAGs]). Specific drugs such as citrate, allopurinol, and thiazide represent highly effective treatments for the promoting factors. Furthermore, recent findings suggest an interesting role for a phytotherapeutic agent, Phillantus niruri, and its inhibitory action on calcium oxalate crystallization related to the higher incorporation of GAGs into the calculi. Another step forward in medical management of stone disease is expulsive therapy. Many studies have proven the efficacy of medical expulsive therapy with nifedipine and alpha-blockers: their specific action on ureteral smooth muscle in association with anti-edema drugs accounts for their efficacy in expelling ureteral stones. In this paper, we provide an update on the medical treatment of stone disease, focusing our attention on what is known and what is new in renal colic and litholithic and expulsive medical therapy.

Nonsurgical Management of Urolithiasis: An Overview of Expulsive Therapy

Although minimally invasive stone therapies such as shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy are efficacious, these techniques are not free of risks and are relatively expensive. Watchful waiting may be appropriate in patients without infection whose pain can be controlled with oral medication but is associated with pain, uncertainty, potential risks to renal function, and time lost from work. Hydroxyprogesterone, prostaglandin synthetase inhibitors, calcium-channel blockers such as nifedipine, alpha-1 blockers such as tamsulosin, and corticosteroids may have some beneficial effect. Future studies are likely to provide additional data in support of their use.

Urinary tract infection in the users of depot-medroxyprogesterone acetate

BACKGROUND

The effects of progesterone on muscle tone, peristalsis of the ureter and also urinary vasculature may cause urinary tract infection (UTI) in women who use depot-medroxyprogesterone acetate (DMPA) for contraception.

METHODS

In a cohort study, 200 women who chose DMPA for contraception were compared with 200 women who used the withdrawal method for urinary infection and urological symptoms after 3 months of consumption.

RESULTS

The rate of urinary infection and urological symptoms in the study group were higher than in the control group (p = 0.018, p < 0.0001, respectively). The most common microorganism that caused urinary infection was Escherichia coli. Among the 10 cases who suffered UTI in the case group, there were six women who had UTI in the previous pregnancy as well.

CONCLUSION

We do not recommended administering depot-medroxyprogesterone acetate for contraception in women with a history of urinary tract infection in a previous pregnancy.

The effect of hydroxyprogesterone on ureteral stones

It has been suggested that dilatation of the ureter seen in pregnancy is caused by progesterone. Twenty-four patients with ureteral calculi, therefore, were given an intramuscular injection of 250 mg hydroxyprogesterone in order to facilitate the discharge of the stones. Irrespective of the duration of symptoms there was a potential effect of treatment in up to 66% of the patients. In patients with symptoms of less than three weeks duration the stones were discharged within three weeks after the first symptom in 75% of the cases, which is a much higher incidence rate than that stated in the literature for spontaneous stone discharge (18-30%). In patients with longstanding symptoms 50% of the stones had passed, as compared to 39% reported in the literature. Especially concrements with a diameter larger than 4 mm had a better discharge rate. As the treatment is simple, cheap and without side effects, it seems worthwhile trying it in order to avoid surgery.

Acute ureteral colic and fluid intake

In the treatment of acute ureteral colic opinions differ regarding the consequences of fluid intake. This study was undertaken to evaluate a possible relationship between fluid load and the pain. One group of patients received 3 liters of fluid intravenously, while in another group all fluids were withheld. No intergroup differences as regards pain was found after 6 hours of observation.