The long-term results of treatment of urinary stones

A network meta-analysis on the beneficial effect of medical expulsive therapy after extracorporeal shock wave lithotripsy

We applied a newly introduced method, network meta-analysis, to re-evaluate the expulsion effect of drugs including tamsulosin, doxazosin, nifedipine, terazosin and rowatinex after extracorporeal shock wave lithotripsy (ESWL) as described in the literature. A systematic search was performed in Medline, Embase and Cochrane Library for articles published before March 2016. Twenty-six studies with 2775 patients were included. The primary outcome was the number of patients with successful stone expulsion. The data were subdivided into three groups according to duration of follow-up. A standard network model was established in each subgroup. In 15-day follow-up results, SUCRA outcome showed the ranking of effects was: doxazosin > tamsulosin > rowatinex > nifedipine > terazosin (88.6, 77.4, 58.6, 32.2 and 30.4, respectively). In 45-day follow-up results, SUCRA ranking was: tamsulosin > nifedipine > rowatinex (69.4, 67.2 and 62.6, respectively). In 90-day follow-up results, SUCRA ranking was: doxazosin > rowatinex > tamsulosin (84.1, 68.1 and 49.1, respectively). In conclusion, doxazosin and tamsulosin have potential to be the first choice for pharmacological therapy to promote the expulsion of urinary stone fragments after ESWL, with this doxazosin can improve the SFR in the long term, while tamsulosin may result more in accelerating the process of expulsion.

Essential oil terpenes: adjunctive role in the management of childhood urolithiasis

Essential oil preparation of the terpenic type was introduced for the first time in the 1930s for the management of urolithiasis. Although essential oil preparations are registered in 50 countries, including some developed countries such as the United Kingdom, Italy, and Japan, for use in urolithiasis, no literature has been published in a peer-reviewed English (Anglo-American) medical journal. Recently the use of these terpenes has been investigated in children with urolithiasis and underlying metabolic abnormalities. The aim of this article is to extract the useful and worthy information about the use of these terpenes in urolithiasis from the previous literature as many of these articles are now considered of poor quality for a thorough systematic scientific review. The main disadvantages of most of the old literature about terpenes are the treatment was not followed radiologically and most of these articles represent anecdotal reports of spontaneous passage of calculi and symptomatic improvement of colic in association with the use of terpenes. The other aim is to discuss the possible role of essential oil terpenes in the management of childhood urolithiasis.