Sagar, Sabharwal (2013) A prospective randomized double blinded placebo controlled trial to study the effect of diuretics on shock wave lithotripsy treatment of renal and upper ureteric calculi. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION: The introduction of shock wave lithotripsy (SWL) treatment for renal and ureteric calculi in 1983 rapidly replaced open surgery for smaller stones. Over time the indications and techniques have been constantly redefined in pursuit of a better outcome. With the arrival of minimally invasive surgical procedures like ureterorenoscopy (URS), percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) the status of SWL has become all the more threatened. But, the unique stature of SWL as a practically ‘no touch’ approach in the treatment of urolithiasis scores over these minimally invasive techniques. It is therefore imperative, that a continuous effort is made to identify novel methods that can improve the treatment outcome of SWL. One such method proposed is to provide diuresis during the shock wave session to enhance the fragmentation and clearance. This is a prospective randomized double blinded placebo controlled trial that aims to analyse the effect of diuretics on SWL treatment of renal and upper ureteric calculi. MATERIAL AND METHODS: Design and location - This hospital based prospective randomized double blinded placebo controlled trial was conducted at the Department of Urology, Christian Medical College, Vellore. Duration - Between June 2011 and December 2012. Patients - Patients with renal and upper ureteric calculi who satisfied the following inclusion and exclusion criteria were included; Inclusion criteria: Age: adults > 18 years, Non obstructive radio opaque renal and upper ureteric calculi up to 1.5 cm (obstruction – no contrast seen beyond the calculus up to the 1 hour film on intravenous urogram) Sterile or treated urine culture, Normal renal function (creatinine up to 1.4 mg%). Exclusion criteria: Anatomical abnormality, Distal obstruction, Morbid obesity (body mass index > 40), Pregnancy, Coagulopathy, History of any previous intervention on the same side, Significant cardiac history. RESULTS: During the study period from June 2011 to December 2012, a total of 96 patients were included. These comprised both renal and upper ureteric calculi as per inclusion criteria. They were randomised into two groups; Group A: Placebo arm, Group B: 40 mg Furosemide iv arm. The mean age in group A was 39.45 years and group B was 38.56 years. The female to male ratio was almost similar in both groups. There were 30 men and 18 women in group A, whereas in group B it was 31 men and 17 women. The mean weight of the patients in group A was 61.16 kg and in group B was 61.39 kg. The mean calculus size in group A was 9.26 mm and group B was 9.41 mm. CONCLUSIONS: The use of diuretics along with SWL treatment of renal and upper ureteric calculi results in higher fragmentation and clearance rates along with a requirement of lower number of shocks and sessions, though not statistically significant.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | prospective randomized double blinded placebo controlled trial ; diuretics ; shock wave lithotripsy treatment ; renal ; upper ureteric. calculi |
| Subjects: | MEDICAL > Urology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 12 Oct 2017 01:25 |
| Last Modified: | 12 Oct 2017 01:25 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3474 |
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