Medical Treatment of Urinary System Stones

Year 2024, Volume: 16 Issue: 3, 108 - 115, 29.09.2024

Hasan Turgut , Mehmet Sarıer

https://doi.org/10.54233/endourolbull-1493466

Abstract

In urinary tract stone disease, medical treatment is of great importance both to increase stone passage and to prevent recurrence.Adequate fluid intake, dietary habits, increased fiber intake, low vitamin C and protein intake can be recommended in all patients with urolithiasis regardless of stone type.Pharmacologic agents such as alpha blockers and calcium channel blockers have been used for a long time to increase spontaneous passage of urinary tract stones. Medical treatment of calcium stones includes thiazides, alkaline citrate, allopurinol and glycosaminoglycans. Urine alkalinization, restriction of protein and purine intake in the diet and allopurinol are used in the medical treatment of uric acid stones. Urine alkalinization, cystine binding drugs and restriction of methionine intake are effective in cystine stonesUrease inhibitors, antibiotics and urine acidification are commonly used methods in the medical treatment of infection stones

Keywords

Kidney stone, diet therapy, ureteral stone, renal colic, medical expulsive therapy, metaphylaxis

Üriner Sistem Taşlarında Medikal Tedavi

Abstract

Üriner sistem taş hastalığında hem taş pasajını artırmak hem de rekürrensin önlemesinde medikal tedavinin yeri oldukça büyük öneme sahiptir.Yeterli sıvı alımı,diyet alışkanlığı,lifli gıdaların artırılması,düşük c vitamini ve protein alımı taş tipine bakılmaksızın tüm ürolitiazisli hastalarda önerilebilir.Ürine sistem taşlarında taşın spontan pasajını artırmak için alfa bloker ve kalsiyum kanal blokerleri gibi farmakolojik ajanlar uzun süredir kullanılan medikal tedavilerdir. Kalsiyum taşlarının medikal tedavisini tiazidler, alkalen sitrat, allopurinol ve glikozaminoglikanlar oluşturur. Ürik asit taşlarının medikal tedavisinde ise idrar alkalinizasyonu, diyette protein ve pürin alımının kısıtlanması ve allopürinol kullanılır. Sistin taşlarında idrar alkalinizasyonu, sistin bağlayıcı ilaçlar ve metionin alımının kısıtlanması etkilidir. Enfeksiyon taşlarının medikal tedavisinde ise üreaz inhibitörleri, antibiyotikler ve idrar asidifikasyonu yaygın kullanılan yöntemlerdir.

Keywords

Böbrek taşı, diyet tedavisi, üreter taşı, renal kolik, medikal ekspulsif terapi, metaflaksi

References

• 1. Scales CD, Smith AC, Hanley JM, Saigal CS Prevalence of kidney stones in the United States. EurUrol. 2012;62(1):160-165. https://doi.org/10.1016/j.eururo.2012.03.052
• 2. Huang W, Xue P, Zong H, Zhang Y Eficacy and safety of silodosin in the medical expulsion therapy for distal ureteral calculi: a systematic review and meta-analysis. Br J Clin Pharmacol. 2016;81(1):13-22. https://doi.org/10.1111/bcp.12737
• 3. Chung MJ Urolithiasis and nephrolithiasis. J Am Acad Physi Assist 2017; 30(9):49-50. https://doi.org/10.1097/01.jaa.0000522145.52305.aa
• 4. Barnela, S. R., Soni, S. S., Saboo, S. S., et al. Medical management of renal stone. Indian journal of endocrinology and metabolism.2012; 16(2):236-239. https://doi.org/10.4103/2230-8210.93741
• 5. Zumstein, V., Betschart, P., Abt, D., et al. Surgical management of urolithiasis - a systematic analysis of available guidelines. BMC urology. 2018;18(1):25.
• 6. Lee, A., Cooper, M. G., Craig, J. C., et al. Effects of nonsteroidal anti-inflammatory drugs on postoperative renal function in adults with normal renal function. The Cochrane database of systematic reviews. 2007(2):CD002765. https://doi.org/10.1002/14651858.CD002765.pub2
• 7. Coxib and traditional NSAID Trialists (CNT) Collaboration, Bhala, N., Emberson, J., Merhi, A., Abramson, S., et al. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet (London, England).2013; 382(9894):769-779. https://doi.org/10.1016/S0140-6736(13)60900-9
• 8. Pathan, S. A., Mitra, B., & Cameron, P. A. A Systematic Review and Meta-analysis Comparing the Efficacy of Nonsteroidal Anti-inflammatory Drugs, Opioids, and Paracetamol in the Treatment of Acute Renal Colic. European urology.2018; 73(4):583-595. https://doi.org/10.1016/j.eururo.2017.11.001
• 9. EAU Guidelines. Edn. presented at the EAU Annual Congress Paris 2024. ISBN 978-94-92671-23-3. 10. Moussa, M., Papatsoris, A. G., & Chakra, M. A. Intradermal sterile water injection versus diclofenac sodium in acute renal colic pain: A randomized controlled trial. The American journal of emergency medicine.2021; 44:395-400. https://doi.org/10.1016/j.ajem.2020.04.079
• 11. Yilmaz, E., Batislam, E., Basar, M. M., et al. The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones. The Journal of urology,2005; 173(6), 2010–2012. https://doi.org/10.1097/01. ju.0000158453.60029.0a
• 12. Hsu, Y. P., Hsu, C. W., Bai, C. H., et al. Silodosin versus tamsulosin for medical expulsive treatment of ureteral stones: A systematic review and meta-analysis. PloS one, 2018;13(8), e0203035. https://doi.org/10.1371/journal.pone.0203035
• 13. Bai, Y., Yang, Y., Wang, X., Tang, Y., Han, P., & Wang, J. Tadalafil Facilitates the Distal Ureteral Stone Expulsion: A Meta-Analysis. Journal of endourology,2017; 31(6), 557–563. https://doi.org/10.1089/end.2016.0837
• 14. Sasaki S, Tomiyama Y, Kobayashi S, Kojima Y, Kubota Y.,et al.Characterization of α1-adrenoceptor subtypes mediating contraction in human isolated ureters. Urology. 2011; 77:762.e137. https://doi.org/10.1016/j. urology.2010.09.034
• 15. Sun, F., Bao, X., Cheng, D., et al. Meta-Analysis of the Safety and Efficacy of α-Adrenergic Blockers for Pediatric Urolithiasis in the Distal Ureter. Frontiers in pediatrics, 2022;10, 809914. https://doi.org/10.3389/fped.2022.809914
• 16. Thakur, A.P.S., Sharma, V., Ramasamy, V. et al. Management of ureteric stone in pregnancy: a review. Afr J Urol 2020; 26, 60 . https://doi.org/10.1186/s12301-020-00070-5
• 17. Kachrilas, S., Papatsoris, A., Bach, C., et al. The current role of percutaneous chemolysis in the management of urolithiasis: review and results. Urolithiasis,2013;41(4),323-326. https://doi.org/10.1007/s00240-013-0575-6
• 18. El-Gamal, O., El-Bendary, M., Ragab, M., et al. Role of combined use of potassium citrate and tamsulosin in the management of uric acid distal ureteral calculi. Urological research, 2012;40(3), 219–224. https://doi.org/10.1007/s00240-011-0406-6
• 19. Costa MR, Pais VM, Rule AD. Leave no stone unturned: Defining recurrence in kidney stone formers [Internet]. Vol.
• 28, Current Opinion in Nephrology and Hypertension. Lippincott Williams and Wilkins; 2019;p. 148–53. Available from: https://pubmed.ncbi.nlm.nih.gov/30531469/.
• 20. Brain, E., Geraghty, R. M., Lovegrove, C. E., Yang, B., & Somani, B. K. Natural History of Post-Treatment Kidney Stone Fragments: A Systematic Review and Meta-Analysis. The Journal of urology,2021; 206(3), 526–538. https://doi.org/10.1097/JU.0000000000001836
• 21. Yilmaz E, Batislam E, Basar M, Tuglu D, Erguder I. Citrate levels in fresh tomato juice: a possible dietary alternative to traditional citrate supplementation in stoneforming patients. Urology 2008; 71: 379483; discussion 383484[PMID: 18342167 https://doi.org/10.1016/j.urology.2007.08.065
• 22. Kang DE, Maloney MM, Haleblian GE, Springhart WP, Honeycutt EF, et al.: Effect of medical management on recurrent stone formation following percutaneous nephrolithotomy. J Urol. 2007;177:1785-8; discussion 1788-9. https://doi.org/10.1016/j.juro.2007.01.061
• 23. Singh, I., Bishnoi, I., Agarwal, V., et al. Prospective randomized clinical trial comparing phytotherapy with potassium citrate in management of minimal burden (≤8 mm) nephrolithiasis. Urology annals. 2011;3(2):7-81. https://doi.org/10.4103/0974-7796.82172
• 24. Lee, Y. H., Huang, W. C., Tsai, J. Y., et al. The efficacy of potassium citrate based medical prophylaxis for preventing upper urinary tract calculi: a midterm followup study. The Journal of urology. 1999;161(5):1453-1457.
• 25. Pinheiro VB, Baxmann AC, Tiselius HG, Heilberg IP. The effect of sodium bicarbonate upon urinary citrate excretion in calcium stone formers. Urology. 2013;82(1):33-7. https://doi.org/10.1016/j.urology.2013.03.002
• 26. Tsaturyan A, Bokova E, Bosshard P, Bonny O,et al. Oral chemolysis is an effective, non-invasive therapy for urinary stones suspected of uric acid content. Urolithiasis. 2020 Dec;48(6):501-507. https://doi.org/10.1007/s00240-020-01204-8
• 27. Cunha TDS, Gomes SA, Heilberg IP. Thiazide and thiazide-like diuretics in nephrolithiasis. J Bras Nefrol. 2021;43(1):103-109. https://doi.org/10.1590/2175-8239-JBN-2019-0148
• 28. Dhayat NA, Bonny O, Roth B, et al. Hydrochlorothiazide and Prevention of Kidney-Stone Recurrence. N Engl J Med. 2023;388(9):781-791. https://doi.org/10.1056/NEJMoa2209275
• 29. Peerapen P, Thongboonkerd V. Kidney Stone Prevention. Adv Nutr. 2023;14(3):555-569. https://doi.org/10.1016/j.advnut.2023.03.002
• 30. Reichard C, Gill BC, Sarkissian C, De S, Monga M. 100% uric acid stone formers: what makes them different? Urology. 2015;85(2):296-8. https://doi.org/10.1016/j.urology.2014.10.029
• 31. Leslie SW, Sajjad H, Nazzal L. Cystinuria. 2023 Mar 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29262245.
• 32. Rogers, A., et al. Management of cystinuria. Urol Clin North Am, 2007;34:347. https://doi.org/10.1016/j. ucl.2007.04.006
• 33. Jarrar K, Boedeker RH, Weidner W. Struvite stones: long term follow up under metaphylaxis. Ann Urol (Paris).1996;30(3):112-7.