Efficacy of Hydrochlorothiazide in Post Extra Corporeal Shock Wake Lithotripsy Stone-free time in Patients Referred to the ESWL Ward of Moradi Hospital of Rafsanjan

Document Type : Original Article

Authors

1 Assistant Prof, Dept. of Surgery, Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.

2 MScof educational psychology, Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.

3 Medical students, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.

Abstract

Introduction: Extracorporeal shockwave lithotripsy (ESWL) is one of minimally invasive methods for the treatment of renal stones. Several factors affecting success rate of ESWL including; age, gender, weight, stone size, laterality and location of stone and materials stone.
The aim of this study was to evaluate the effect of hydrochlorothiazide on the duration of renal pelvic stone passage after ESWL.
Materials and Methods: In this clinical trial approved by Iranian Registry of Clinical Trials (IRCT20171104037212N2), 199 patients with renal pelvis stone sized smaller than 20mm referred to the ESWL department of Moradi hospital in Rafsanjan during 2015-2016 were included. After ESWL process, patients were randomly divided into two groups; experimental and control groups. The experimental group received 25 mg hydrochlorothiazide tablets every 12 hours for 2 weeks and control group received placebo at the same condition. The Data were analyzed using Mann–Whitney U and Kruskal–Wallis tests.
Results: The success rate of ESWL was 73.0% in the hydrochlorothiazide and 71.7% in the placebo groups (p=0.840). Duration of stone passage in hydrochlorothiazide group was 5.49 ± 2.92 days and in placebo was 6.46±3.98 days (p=0.147). In hydrochlorothiazide group, duration of stone passage in patients with stone size of 16-20 mm was less than patients with stone size smaller than 16 mm (p=0.024). In patients aged 19-35 years old, duration of stone passage in hydrochlorothiazide group (p=0.004) and in the right renal pelvis stone (0.049) was less than placebo. 
Conclusion: The hydrochlorothiazide reduced the stone passage time after ESWL clinically, although not statistically significant. Considering the effectiveness of hydrochlorothiazide in passage of stones in young patients with renal stones of smaller size, it would be among medical interventions in nephrolithiasis.

Keywords


  1. Wein AJ, Kavoussi LR, Partin AW, Peters CA. Campbell-Walsh Urology. 11nd ed. New York: Elsevier; 2015: 1363.
  2. Tanagho EA, McAninch JW. Smith's General Urology .17nd ed. New York: McGraw-Hill Medical; 2007:246.
  3. Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Reviews in urology 2010;12(2-3): 86-96.
  4. Graham SD, Keane TE. Glenn's Urologic Surgery. 8nd ed . Philadelphia: LWW; 2015: 1078.
  5. Stamatelou KK, Francis ME, Jones CA, Nyberg LM, Curhan GC. Time trends in reported prevalence of kidney stones in the United States: 1976-1994. Kidney International 2003;63(5):1817-23.
  6. Weld KJ, Montiglio C, Morris MS, Bush AC, Cespedes RD. Shock wave lithotripsy success for renal stones based on patient and stone computed tomography characteristics. Urology 2007;70(6):1043-6.
  7. Parker-Cohen PD. Extracorporeal shock-wave lithotripsy treatment for kidney stones.The Nurse Practitioner 1988;13(3):32, 7-42.
  8. Moxey-Mims MM, Stapleton FB. Hypercalciuria and nephrocalcinosis in children. Current Opinion in Pediatrics 1993;5(2):186-90.
  9. Ahmed A-f, Shalaby E, Maarouf A, Badran Y, Eladl M, Ghobish A. Diuresis and inversion therapy to improve clearance of lower caliceal stones after shock wave lithotripsy: A prospective, randomized, controlled, clinical study. IJU 2015;31(2):125-31.
  10. Diniz DH, Blay SL, Schor N. Anxiety and depression symptoms in recurrent painful renal lithiasis colic. BJMBR 2007;40(7):949-55.
  11. Alon US, Berenbom A. Idiopathic hypercalciuria of childhood: 4- to 11-year outcome. Pediatric Nephrology 2000;14(10-11):1011-5.
  12. Katzung BG, Masters SB, Trevor AJ. Basic and Clinical Pharmacology. 12nd ed. New York: McGraw-Hill Medical; 2012: 260.
  13. Tehranchi A, Rezaei Y, Mohammadi-Fallah M, Mokhtari M, Alizadeh M, Abedi F, et al. Effects of hydrochlorothiazide on kidney stone therapy with extracorporeal shock wave lithotripsy. Urology annals 2014;6(3):208-11.
  14. Basri C, Sinanoglu O, Mahmure U. The Effect of Tamsulosin on Pain and Clearance According to Ureteral Stone Location After Shock Wave Lithotripsy.CTR 2013;74:33-5.
  15. Mohamed HI. The efficacy of tamsulosin therapy after extracorporeal shock-wave lithotripsy for ureteric calculi: A prospective randomised, controlled study. AJU 2013;11(4):398-404.
  16. Nuss GR, Rackley JD, Assimos DG. Adjunctive Therapy to Promote Stone Passage.Reviews in urology 2005;7(2):67-74.
  17. Azm TA, Higazy H. Effect of diuresis on extracorporeal shockwave lithotripsy treatment of ureteric calculi. SJUN 2002;36(3):209-12.
  18. Zomorrodi A, Golivandan J, Samady J. Effect of diuretics on ureteral stone therapy with extracorporeal shock wave lithotripsy.SJDT 2008;19(3):397-400.
  19. Massoud AM, Abdelbary AM, Al-Dessoukey AA, Moussa AS, Zayed AS, Mahmmoud O. The success of extracorporeal shock-wave lithotripsy based on the stone-attenuation value from non-contrast computed tomography.AJU 2014;12(2):155-61.
  20. Lieske JC, Rule AD, Krambeck AE, Williams JC, Bergstralh EJ, Mehta RA, et al. Stone Composition as a Function of Age and Sex. CJASN 2014;9(12): 2141-6.
  21. Lu X, Wang J, Cao X, Li M, Xiao C, Yasui T, et al. Gender and urinary pH affect melamine-associated kidney stone formation risk. Urology annals 2011;3(2):71-4.
  22. Saxon SV, Etten MJ. Physical Change And Aging: A Guide For The Helping Professions. 4nd ed. New York: Springer Publishing Company; 2002: 189.
  23. Pareek G, Armenakas NA, Panagopoulos G, Bruno JJ, Fracchia JA. Extracorporeal shock wave lithotripsy success based on body mass index and Hounsfield units. Urology 2005;65(1):33-6.
  24. McClain PD, Lange JN, Assimos DG. Optimizing Shock Wave Lithotripsy: A Comprehensive Review. Reviews in urology 2013;15(2):49-60.
  25. McAdams S, Kim N, Ravish IR, Monga M, Ugarte R, Nerli R, et al. Stone size is only independent predictor of shock wave lithotripsy success in children: a community experience. The journal of urology 2010;184(2):659-64.