Daga Sudarshan, Wagaskar Vinayak G, Tanwar Harshawardhan, Shelke Umesh, Patil Bhushan, Patwardhan Sujata
Department of Urology, King's Edward Memorial Hospital, Mumbai, India.
Urol J. 2016 Dec 8;13(6):2893-2898.
Natural history and modality of treatment for asymptomatic renal calculi less than or equal to 5 millimetres in size is still unknown. Many options are available ranging from medical expulsive therapy to minimally invasive surgery. Till date no study has focussed on this very common but asymptomatic issue. Hence, this study is undertaken to evaluate efficacy of medical expulsive therapy in renal calculi less than or equal to 5mm in size.
A prospective, parallel group, randomized study was carried out from 1st June 2014 to 31st May 2015, with total of 100 patients, 50 patients in each group. Patients with renal stones less than or equal to 5mm were included in the study. Group A Patients were administered medical expulsive therapy which included tamsulosin 0.4 mg daily at night time, furosemide 20mg, spironolactone 50mg in a single morning dose, and syrup potassium magnesium citrate 20Meq per dose three times a day for 12 weeks while group B patients were given placebo. The primary outcome variable was number of patients achieving clearance of stone during 12-week treatment period in both groups.
No statistically significant differences in age, gender, stone size, and calyceal stone location was found between the two treatment arms. A spontaneous stone expulsion rate of 50% (at 6 weeks) and 86 %( at 12 weeks) was noted in group A versus 28% (at 6 weeks) and 38 % (at 12 weeks) in group B. Less number of pain episodes and less analgesic medication was required in group A as compared to group B.
Medical Expulsive therapy for 12 weeks significantly improves stone free rates in renal calyceal calculi less than or equal to 5mm.
直径小于或等于5毫米的无症状肾结石的自然病史和治疗方式仍不明确。从药物排石治疗到微创手术，有多种选择。迄今为止，尚无研究关注这个非常常见但无症状的问题。因此，本研究旨在评估药物排石治疗对直径小于或等于5毫米肾结石的疗效。
2014年6月1日至2015年5月31日进行了一项前瞻性、平行组、随机研究，共100例患者，每组50例。纳入直径小于或等于5毫米肾结石的患者。A组患者接受药物排石治疗，包括每晚服用坦索罗辛0.4毫克、早上单次服用速尿20毫克、螺内酯50毫克，以及每天三次、每次剂量为20毫当量的糖浆型枸橼酸钾镁，持续12周；而B组患者服用安慰剂。主要结局变量是两组在12周治疗期内结石清除的患者数量。
两个治疗组在年龄、性别、结石大小和肾盂结石位置方面未发现统计学上的显著差异。A组自发排石率在6周时为50%，12周时为86%；而B组在6周时为28%，12周时为38%。与B组相比，A组疼痛发作次数更少，所需止痛药物也更少。
12周的药物排石治疗显著提高了直径小于或等于5毫米肾盂结石的无石率。
