2nd Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Curr Opin Urol. 2021 Mar 1;31(2):102-108. doi: 10.1097/MOU.0000000000000844.
Surgical management is the cornerstone of urolithiasis treatment, but high recurrence rates and associated complications necessitate the existence of medical treatment options, aiming at dissolution of kidney stones and prevention of recurrence. The purpose of this review is to present the most recent knowledge existing in scientific literature, regarding dissolution therapy and ways of monitoring nephrolithiasis patients.
A number of laboratory studies have been performed testing experimental treatments (tolvaptan, chlorthalidone, atorvastatin, a-lipoic acid, glucosaminoglycans, plant extracts), to reduce kidney stone formation and cellular damage and showed encouraging results. Uric acid stones is the main target of dissolution therapy, but until last years, existing level of evidence was low. A number of prospective and randomized studies, proved the efficacy and safety of oral chemolysis for radiolucent stones and associated prognostic features of success. Tolvaptan and a-Lipoic acid were also tested in patients with cystinuria and resulted in reduction of recurrence. Finally, some new diagnostic markers are suggested as tests for the monitoring of urolithiasis patients, with satisfying accuracy and discriminative ability.
Medical dissolution therapy for nephrolithiasis is an effective option, especially for patients with radiolucent/uric acid stones. In the future, we need clinical trials to confirm the encouraging results of pilot studies testing several agents for patients with cystinuria.
手术治疗是治疗尿路结石的基石，但高复发率和相关并发症的存在需要有治疗选择，旨在溶解肾结石并预防复发。本文旨在介绍科学文献中关于溶解疗法和监测肾结石患者的最新知识。
许多实验室研究已经对实验性治疗方法（托伐普坦、氯噻酮、阿托伐他汀、α-硫辛酸、氨基葡萄糖聚糖、植物提取物）进行了测试，以减少肾结石的形成和细胞损伤，并取得了令人鼓舞的结果。尿酸结石是溶解疗法的主要目标，但直到最近几年，证据水平仍然较低。一些前瞻性和随机研究证实了口服化学溶解治疗透光结石的疗效和安全性及其相关的成功预测因素。托伐普坦和 α-硫辛酸也在胱氨酸尿症患者中进行了测试，结果显示复发率降低。最后，一些新的诊断标志物被建议作为监测肾结石患者的检测方法，具有令人满意的准确性和区分能力。
对于肾结石患者，医学溶解疗法是一种有效的选择，尤其是对于透光/尿酸结石患者。未来，我们需要临床试验来证实针对胱氨酸尿症患者的几种药物的试验性研究的令人鼓舞的结果。
