Zomorrodi A, Golivandan J, Samady J
Imam Hospital, Tabriz Medical Science University, Tabriz, Iran.
Saudi J Kidney Dis Transpl. 2008 May;19(3):397-400.
To evaluate the effect of diuretics on ureteral stone fragmentation and clearance during therapy with extra corporeal shock wave lithotripsy (ESWL), we studied 87 patients with ureteral stone at different levels and treated with ESWL. The patients were randomized into two groups treated by standard ESWL; the treatment protocol included 3500 shock wave per patient in each session, energy of the shock in two groups was 13 to 9 kv per patient, and the number of sessions was 3 per patient. The first group included 43 patients who received only ESWL, while the second group of 44 patients received as well 40 mg of furosemide. Stone fragmentation rate was 81% and 93.1% and stone clearance rate was 68.2% and 88.4% for the first and the second groups, respectively. With diuretics, fragmentation was 18.8% more in the middle ureteral stones, 16.9% more in the upper tract stones, and 5.4% more in the distal stones. Moreover, clearance of fragmented stones was 38%, 28%, 15.4% more at middle and upper and distal ureteral stone, respectively. We conclude that the stone fragmentation and clearance were higher with ESWL and diuretics than without diuresis. Diuresis is safe and has some advantage at increasing the effect of ESWL on ureteral stones especially the middle ureteral calculi.
为评估利尿剂在体外冲击波碎石术（ESWL）治疗输尿管结石过程中对结石碎裂和清除的影响，我们研究了87例不同部位输尿管结石且接受ESWL治疗的患者。患者被随机分为两组接受标准ESWL治疗；治疗方案为每次每位患者3500次冲击波，两组患者的冲击波能量均为13至9千伏，每位患者治疗3次。第一组43例患者仅接受ESWL治疗，而第二组44例患者除接受ESWL治疗外还服用40毫克速尿。第一组和第二组的结石碎裂率分别为81%和93.1%，结石清除率分别为68.2%和88.4%。使用利尿剂后，输尿管中段结石的碎裂率增加18.8%，上段结石增加16.9%，下段结石增加5.4%。此外，输尿管中段、上段和下段结石碎裂后的清除率分别提高38%、28%和15.4%。我们得出结论，ESWL联合利尿剂治疗时结石的碎裂和清除率高于未使用利尿剂的情况。利尿剂安全，在增强ESWL对输尿管结石尤其是输尿管中段结石的治疗效果方面具有一定优势。
