Flomax for Kidney Stones | Flomax Side Effects

Medical knowledge is always evolving. New treatments are often released to improve the symptoms of patients while reducing the incidence of side effects.  

Similarly, recent advancements in the medical sciences have uncovered the role of Flomax to treat kidney stones, a medication originally designed for patients with benign prostatic hyperplasia (BPH). 

However, what is Flomax, and how does Flomax work in cases of kidney stones? Is it an effective and safe treatment? Does it replace surgery and other therapeutic options?

What is Flomax? 

Flomax is the trade name of tamsulosin, a medication that treats benign prostatic hyperplasia.

It is an alpha-blocker, which means it interferes with the nervous transmission of a  group of neurons by blocking a series of receptors.

The main effect in benign prostatic hyperplasia is relaxing the muscles of the prostate. It is useful to relieve the urinary symptoms that result from an enlargement of the prostate gland.

After its release in 1997, tamsulosin started to be prescribed.  Not only to improve the symptoms of BPH but also for other urinary problems.  These include acute urinary retention and to pass kidney stones faster and with reduced severity of symptoms (1). 

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What are kidney stones? 

Kidney stones are one of the most common causes of visits to the emergency department worldwide.

It is estimated that most people will experience symptoms of kidney stones at some stage in their lives. They form from calcium oxalate crystals or uric acid crystals.

Kidney stones grow as a buildup of various compounds that become sedimented in the upper urinary tract. The majority of them are not noticed because they do not grow big enough and can be eliminated without any significant symptoms.  

Larger kidney stones cause severe pain and other symptoms that often lead patients into an emergency room.

The majority of cases are solved by urinary elimination, dissolving kidney stones, and treating pain. However, in some cases, kidney stones are very large and should be surgically removed.

There are a wide variety of medications and dietary recommendations to treat patients with kidney stones.  Various preventative measures to reduce the incidence of recurrence in these patients.

However, the best treatment option usually depends on the chemical composition of the kidney stones. It is also dependent on the size, location, and whether or not it has triggered an infection of the urinary tract (2). 

Symptoms of kidney stones 

Many patients with small kidney stones do not display any symptoms throughout their lifetime.

In these cases, kidney stones are very small, and they eliminate without symptoms when patients urinate. However, when symptoms start to appear, they usually include pain, blood in the urine, and nausea with or without vomiting.  

Pain triggered by kidney stones is often located on the affected side of the spine, below the ribcage, which is why it is described as flank pain.

The nature of the pain is variable, and it often irradiates to the groin, testicles, labia majora, or the legs. It is a very intense pain, and it is often accompanied by profuse sweating, nausea, and vomiting. 

Not every case of kidney stones includes blood in the urine as a symptom. However, it is an important sign that the stone is passing through the urinary tract.

Other symptoms include a burning sensation while urinating and fever, especially when there’s a urinary tract infection associated with an injury to the inner linings of the urinary tract (3). 

How does Flomax work for kidney stones? 

Flomax is an alpha-blocker, and in the urinary tract, there are various forms of alpha-adrenergic receptors. These receptors link to smooth muscle. When they become activated would trigger muscle contraction.

This leads to a relaxation of the smooth muscle, that limits not only to the prostatic urethra but the rest of the urinary tract as well. This effect is more pronounced in the distal portion of the ureters and the bladder neck, areas with a higher concentration of alpha 1D receptors (4). 

When kidney stones are working their way through the ureters, the smooth muscle typically contracts. This can lead to a risk of entrapment of the stone and limiting its progression through the urinary tract (5).

In these cases, Flomax mediates relaxation of smooth muscles in the ureters. This, in turn, improves the flow of urine and solves the obstruction triggered by kidney stones and aggravated by smooth muscle contraction.

This effect by tamsulosin would also reduce the consequences of mechanical obstruction in the urinary tract. Such as hydronephrosis (swelling of the kidney that results from a backward flow and accumulation of urine). And complete urinary obstruction (an emergency situation attended by the urologist) (6).  

Is Flomax an effective treatment for kidney stones? 

Flomax (tamsulosin) is efficient in various studies. It can significantly reduce the time of the expulsion of these stones from the urinary tract.

Flomax for kidney stones

For instance, one study reports a 72% frequency of kidney stone expulsion in patients using Flomax against 30% in patients receiving placebo medications (7). 

Studies have also revealed that Flomax is an effective treatment to eliminate kidney stones smaller than 10 millimeters (9).

Studies show Tamsulosin can reduce elimination time in cases of kidney stones significantly. For example, one clinical trial reported that the elimination of kidney stones in a study took a mean of 7 days for the study group. This is in comparison to 9 days in patients who took placebo medications (7).

Moreover, in a subgroup of patients who had kidney stones smaller than 10 millimeters and located in the distal portion of the ureters, tamsulosin promotes expulsion of calculi in 4 days. This is in comparison to other traditional medications to manage kidney stones, which took a mean of 7 days (9).

Flomax is more useful for kidney stones located in the distal portions of the ureters. But, although lower, there’s still a significant reduction in elimination time for stones located in proximal areas of the urinary tract as well (10). 

The role of Flomax to treat kidney stones also includes emergency settings. 

What The Research Says

According to various clinical trials performed over the years, elimination is more efficient with Flomax for ureteral calculi located in the distal portion of the ureters.  This is the area where there is a higher concentration of alpha-adrenergic receptors (8).

Studies have evaluated the use of tamsulosin in patients with acute renal colic.

The results show that patients receiving tamsulosin in the emergency room have a lower requirement of pain medication and anesthetics. They also have a significant reduction in their hospital stay and lower the need for surgical removal (11).

These results of applying Flomax in the treatment of kidney stones may even lead to an estimated reduction of 29% in frequency of visits to the emergency department and a 24% reduction in healthcare expenses (12). 

The 2016 American Urological Association guidelines for the management of stones indicates that alpha-blockers may be beneficial for stones that are less than 10mm.  However, research is not conclusive on the use of tamsulosin in the treatment of kidney stones.

Recent research in the Journal of the American Medical Association concludes that tamsulosin was not effective in increasing the passage time for stones less than 9mm when compared with placebo.

Side effects of Flomax 

Tamsulosin belongs to a family of drugs with a specific affinity for alpha-adrenergic receptors. More specifically, the alpha 1 A and D sub-class. 

The known side effects reported so far dizziness and headaches. For the treatment of benign prostatic hyperplasia, further reported side effects include decreased ejaculation, blurred vision, and priapism.

Further treatment options for kidney stones 

There are plenty of therapeutic strategies for kidney stones. And there are both pharmacological and surgical options to choose from. However, this depends on the size and location of the calculi (3). 

• Thiazide diuretics: They are commonly prescribed to encourage the urinary flow and reduction of urinary calcium that may reduce the recurrence of kidney stones in individual patients (2). 

• Potassium citrate: Should encourage in calcium stone-forming patients to reduce the risk of kidney stone recurrence. It also increases the urinary pH and reduces the formation of uric acid stones. Potassium supplementation may also be required when thiazide diuretics are prescribed (2). 

• Allopurinol: A drug employed to reduce the production and accumulation of uric acid. Doctors may prescribe it to patients with kidney stones, normal urinary calcium, and high levels of uric acid in the urine (2).  

• Dietary modifications: Patients are often encouraged to increase liquid intake throughout the day, reduce sodium consumption and non-dairy animal protein, aiming at 1,000 to 1,200 mg of dietary calcium per day. Reducing the use of oxalate-rich foods is more important than reducing the consumption of calcium sources (2). 

• Surgical measures: There are various minimally invasive and invasive procedures to clear kidney stones. These include extracorporeal shock wave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy. Some of them require a postoperative ureteral stent, and the majority are outpatient procedures (3). 

Conclusion 

Flomax is now becoming an essential part of the treatment in cases of kidney stones. However, despite being commonly prescribed, it can have severe side effects that patients should know. 

Flomax has the potential to interfere with a large number of medications to include warfarin and vasodilators. Therefore, it is imperative to speak with your doctor about any current medications you may be taking.

We know Flomax can induce relaxation of the smooth muscle in the urinary tract. It may also reduce the effect of entrapment that often leads to urinary obstruction in cases of kidney stones.

Guidelines for the management of stones indicate that alpha-blockers may be beneficial for stones that are less than 10mm.  However, some research concludes that tamsulosin was not effective in increasing the passage time for stones less than 9mm in comparison to placebo.

Before taking Flomax, discuss both the benefits and the drawbacks of this medication with your doctor. Depending on the size of your kidney stones, it can be an effective treatment.  But for smaller stones, dietary changes and reduce sodium intake may speed up the passing of kidney stones.

Next Up

Find out 5 Natural Alternatives To Flomax.

Drug May Ease Passage When Kidney Stone Strikes – WebMD

By Robert Preidt

HealthDay Reporter

WEDNESDAY, July 29, 2015 (HealthDay News) — Kidney stones can quickly cause extreme pain, and passing the stones is the immediate goal for patients.

Now, a new study finds that the drug tamsulosin (Flomax) can boost the passage of large kidney stones, but not small ones.

“Small stones usually pass on their own, so it’s not too surprising that drug therapy did not help in this study,” said Dr. Warren Bromberg, chief of urology at Northern Westchester Hospital in Mt. Kisco, N.Y.

On the other hand, “anything that assists in passing a large stone, which otherwise would lead to prolonged pain and surgical intervention, is well worth it,” said Bromberg, who was not involved in the new research.

The study was led by Jeremy Furyk of Townsville Hospital in Queensland, Australia. His team found that 28 days after visiting an emergency department for any size of kidney stone, 87 percent of patients treated with tamsulosin and nearly 82 percent of those treated with a placebo passed their kidney stones.

That difference was not considered significant, the researchers noted.

However, among patients with large stones — between 5 and 10 millimeters long — about 83 percent of patients who took tamsulosin passed stones, compared with 61 percent of those who received a dummy medication.

The study was published online July 17 in the Annals of Emergency Medicine.

“Kidney stones bring more than a million Americans a year to emergency departments because they are excruciatingly painful,” Furyk said in a journal news release.

“The news on small kidney stones isn’t positive, but tamsulosin appears to offer benefit to those unlucky people whose kidney stones are really big,” he said.

And, “for patients with small kidney stones, time seems to be the one sure cure,” Furyk said. “However, when treating patients with large kidney stones, emergency physicians should definitely consider tamsulosin,” he concluded.

Bromberg said the introduction of medicines into kidney stone care has upped passage rates while reducing pain. Other drugs in the same class as tamsulosin, such as terazosin and doxazosin, appear to be equally effective, Bromberg noted.

Dr. David Hoenig is a specialist in kidney stone treatment and chief of urology at North Shore-LIJ’s Arthur Smith Institute for Urology, in New Hyde Park, N. Y. He said that when stones become lodged in the ureter — the channel between the bladder and the kidney — “extreme pain” often brings patients to the ER.

“Many stones do pass on their own — as long as pain is controlled and there is no fever, a period of observation for spontaneous passage is reasonable,” Hoenig said. “Follow-up is critical, however: long term blockage of the kidney, untreated, can lead to kidney damage.”

Tamsulosin: a medicine used to treat men with symptoms of an enlarged prostate

Tamsulosin comes as slow-release tablets and capsules (also called modified release, prolonged release, MR or XL).

This means the medicine is released into your body gradually.

How much will I take?

The usual dose of tamsulosin for enlarged prostate and kidney stone is 400 micrograms, once a day. The word microgram is sometimes written with the Greek symbol μ followed by the letter g (μg). A microgram is 1,000 times smaller than a milligram (mg).

How to take it

Swallow your tamsulosin capsules or tablets whole with a glass of water.

Do not break, chew or crush them.

If you can, take tamsulosin in the morning, after breakfast or the first meal or snack of the day. This is so the highest levels of medicine are in your body during the day and gives you the most benefit when you are most likely trying to pee.

It’s best to take it at about the same time each day.

What if I forget to take it?

If you miss a dose of tamsulosin, and you remember within 6 hours, take the missed dose as soon as you remember. If it’s more than 6 hours, skip the missed dose and take your next dose at the usual time the next day.

Do not take a double dose to make up for a forgotten dose.

If you forget doses often, it may help to set an alarm to remind you.

You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

Taking too much tamsulosin can lead to a decrease in your blood pressure and an increase in your heart rate. You may feel drowsy, faint and lightheaded.

If you need to go to hospital, do not drive yourself – get someone else to drive you or call an ambulance.

Take the tamsulosin packet, or the leaflet inside it with you plus any remaining medicine.

Flomax for Females?

If you see a lot of older male patients, it’s likely that you’ve often had a conversation about the ocular effects of Flomax (tamsulosin, Boehringer Ingelheim/Astellas Pharma), an oral medication for men who suffer from benign prostatic hypertrophy (BPH). Flomax, an alpha-1a blocker, decreases symptoms of BPH such as frequency, urgency, weak urine stream, difficulty in starting urine flow, dysuria and nocturia.

The decrease in BPH symptomatology observed with tamsulosin is directly related to the drug’s ability to preferentially antagonize alpha-1a receptors and, therefore, relax smooth muscle in the prostate and bladder neck. Although other non-subtype alpha-1 blockers exist, tamsulosin’s affinity and selectivity for the alpha-1a receptor subtype results in superior efficacy in treating BPH without the hypotensive side effects common with less selective agents.¹ Unfortunately, it also relaxes the iris dilator muscle, leading to miosis.

In recent years, the use of tamsulosin has expanded to off-label indications in both men and women. Here is an overview. 

Off-Label Uses

The most common off-label use of tamsulosin is to assist in the passage of kidney stones by increasing urinary fluid volume and pressure as well as relaxing smooth muscle in the ureters. ² Studies have verified that tamsulosin increases the expulsion rate of kidney stones while decreasing the time to expulsion and the need for adjunctive pain management, hospitalization and surgical intervention.³

Tamulosin is also prescribed off-label to men and women to treat overactive bladder, to facilitate voiding in patients with and without multiple sclerosis (MS) and to treat patients with urinary retention.^4,5 Like its mechanism of action in BPH, tamsulosin is effective by antagonizing alpha-1a receptors with subsequent relaxation of urinary track smooth muscle.⁶

The expanded use of tamsulosin is important to optometrists because of its well-established association with intraoperative floppy iris syndrome (IFIS). The condition, with its associated perioperative cataract surgery concerns, was first reported in 2005 by David F. Chang, M.D., and John R. Campbell, M.D.

IFIS is precipitated by the drug’s effect on the iris dilator smooth muscle and is characterized by poor pupillary dilation before surgery, progressive miosis during the procedure, iris movement and undulation hindering phacoemulsification, iris prolapse through the cataract incision site and posterior capsule rupture.

Most recently, an increased risk of postoperative complications has also surfaced regarding the use of Flomax. Patients who currently use the drug, and even patients who have used an alpha-1a blocker in the past, are more at risk for postoperative complications including retinal detachment, lost lens fragments and severe inflammation or infection.⁸

Beyond Flomax

With the FDA’s approval of a generic tamsulosin formulation in 2010, more patients have greater access to the medication. Practitioners should also be aware of the FDA-approved branded combination product called Jalyn (dutasteride and tamsulosin hydrochloride, GlaxoSmithKline), which combines tamsulosin with the 5-reductase inhibitor dutasteride to reduce symptoms associated with BPH.

Another alpha-1a selective blocker, Rapaflo (silodosin, Watson), received FDA approval in 2008 and, as suspected, has had reports of IFIS. Non-subtype specific alpha blockers such as Hytrin (terazosin hydrochloride, Abbott Labs), Cardura (doxazosin mesylate, Pfizer), and Uroxatral (alfuzosin hydrochloride, Sanofi-Aventis) have had reports of IFIS but are rare compared with the alpha-1a selective products.

Be Prepared

In order to decrease the surgical ophthalmic risks associated with alpha-1a blockers, eye care practitioners must take heed of the Boy Scout motto “be prepared.” Unfortunately, stopping the medication before surgery has not proven to lessen or halt IFIS and is generally not recommended. Knowledge of the patient’s previous or current use of an alpha-1a blocker, however, will allow the surgeon to take preoperative and intraoperative precautions, which will allow for fewer IFIS complications. Here are some recommendations for the management of IFIS.

Most ophthalmologists agree the biggest threat with a Flomax patient involves the inability to maintain good pupillary dilation during the surgery. In a survey of high-volume ophthalmologists skilled in managing IFIS, there are various recommendations for achieving and maintaining an adequate pupil size. The use of atropine 1% has been described three to seven days pre-op as well as the use of an intracameral epinephrine/lidocaine mixture. Both of these techniques increase pupillary dilation and decrease progressive miosis. Surgeons also recommend having iris hooks and/or capsular tension rings available in case their pharmacological approach fails.

Healon 5 (Abbott Medical Optics), as both a cohesive and dispersive viscoelastic agent, is the preferential viscoelastic for patients who exhibit IFIS. Its unique properties help to promote pupillary dilation and keep the iris from billowing and prolapsing into the incision sites.

Finally, some surgeons alter their phacoemulsification settings at various stages of the procedure in patients who exhibit IFIS. This often will result in a longer surgical case but a less complicated one.

With the increased and expanded use of tamsulosin and other alpha-1a antagonists for males and females alike, eye care practitioners should be diligent in reviewing each patient’s medication history and informing the surgeon when referring for cataract surgery. Asking your patient about current or previous urinary tract or prostate issues is an easy way to determine potential problems. This information is especially important for cataract surgeons, optometrists in surgical centers who provide pre- and postoperative care and primary care optometrists who are referring patients for surgery. 

1. Lepor H. The evolution of alpha-blockers for the treatment of benign prostatic hyperplasia. Rev Urol. 2006;8(Suppl 4):S3-9.

2. Lipkin M, Shah O. The use of alpha-blockers for the treatment of nephrolithiasis. Rev Urol. 2006;8(Suppl 4):S35-42.

3. Al-Ansari A, Al-Naimi A. Efficacy of tamsulosin in the management of lower ureteral stones: a randomized double-blind placebo-controlled study of 100 patients. Urology. 2010 Jan;75(1):4-7.

4. Rietz A, Haferkamp A, Kyburz T, et al. The effect of tamsulosin on the resting tone and the contractile behavior of the female urethra: a functional urodynamic study in healthy women. 2004 Aug;46(2):235-40; discussion 240.

5. Chang SJ, Chiang IN, Yu HJ. The effectiveness of tamsulosin in treating women with voiding difficulty. Int J Urol. 2008 Oct;15(11):981-5.

6. Yasuda T, Yasuda K, Kamai T, et al. Combination of a cholinergic drug and an α-blocker is more effective than monotherapy for the treatment of voiding difficulty in patients with underactive detrusor. Int J Urol. 2004 Feb;11(2):88-96.

Additional references available at www.reviewofcontactlenses.com.

7. Chang DF, Campbell JR. Intraoperative floppy iris syndrome associated with tamsulosin (Flomax). J Cataract Refract Surg. 2005 Apr;31(4):664-73.

7. Bell CM, Hatch WV, Fischer HD, et al. Association between tamsulosin and serious ophthalmic adverse events in older men following cataract surgery. JAMA. 2009 May 20;301(19):1991-6.

Symptoms, Causes, Diagnosis, Treatment & Prevention

Overview

What’s a kidney stone?

A stone in your kidney is an irregularly-shaped solid mass or crystal that can be as small as a grain of sand up to the size of a golf ball. Depending on the size of your kidney stone (or stones), you may not even realize that you have one. Even small stones can cause extreme pain as they exit your body through your urinary tract. Drinking fluids may help the process, which can take as long as three weeks.

A large kidney stone can get trapped in your ureter (the tube that drains urine from your kidney down to your bladder). When this happens, the stone can cause bleeding and keep urine from leaving your body. You may need surgery for a stone that can’t pass on its own.

How common are kidney stones?

Researchers have concluded that about one in ten people will get a kidney stone during their lifetime. Kidney stones in children are far less common than in adults but they occur for the same reasons. They’re four times more likely to occur in children with asthma than in children who don’t have asthma.

Who’s most likely to get kidney stones? What are the risk factors?

White men in their 30s and 40s are most likely to get kidney stones. However, anyone can develop kidney stones.

There are several risk factors for developing kidney stones. These include:

• Not drinking enough liquids.
• Having a diet that includes the substances that form the stones (phosphate, for example, is in meat, fish, beans and other protein-rich foods).
• Having a family history of kidney stones.
• Having a blockage in your urinary tract.

Certain medical conditions can also increase your risk of developing stones. This is because they may increase or decrease levels of the substances that make up a kidney stone. These conditions can include:

Some medications can increase your risk of developing a stone. These medications include:

• Diuretics (water pills).
• Calcium-based antacids (used to treat osteoporosis).
• Crixivan® (used to treat HIV infections).
• Topamax® and Dilantin® (used to treat seizures).
• Cipro® (ciprofloxacin, an antibiotic).
• Ceftriaxone (an antibiotic).

Certain foods can also place you at risk of a kidney stone. These foods include:

• Meats and poultry (animal proteins).
• Sodium (diets high in salt).
• Sugars (fructose, sucrose and corn syrup).

Are kidney stones genetic (hereditary)?

Yes, kidney stones can run in families.

What’s the urinary tract? How does it work?

Your urinary tract is vital to your body because it gets rid of waste and extra fluid. It’s made up of both your kidneys, two ureters, your bladder and your urethra. Each organ has an important job (in the following order):

• Kidneys: Your fist-sized, bean-shaped kidneys are located on either side of your spine, below your rib cage. Each day they filter 120 to 150 quarts of your blood to remove waste and balance fluids. Your kidneys make one to two quarts of urine every day.
• Ureters: After your kidney creates urine, the liquid travels through the tube-shaped ureter to the bladder. There is one ureter per kidney. Kidney stones can pass through the ureters or, if they’re too big, get stuck in them. You may require surgery if the stone is too large.
• Bladder: Between your hip bones is your bladder, an organ that stores urine. It stretches to hold about one and a half to two cups.
• Urethra: Like a ureter, your urethra is a tube through which urine passes. It’s the final stop of the urinary tract where your urine (and a kidney stone) leaves your body. This is called urination.

How long does it take a kidney stone to form?

You can have kidney stones for years without knowing they’re there. As long as these stones stay in place within your kidney, you won’t feel anything. Pain from a kidney stone typically starts when it moves out of your kidney. Sometimes, a stone can form more quickly — within a few months.

Talk with your healthcare provider about your risk factors. They might do a 24-hour urine test to check how quickly you develop stones.

What are the most common types of kidney stones?

The most common type of kidney stone is a calcium oxalate stone. This type happens when calcium and oxalate combine in your urine. It can happen when you have high quantities of oxalate, low amounts of calcium and aren’t drinking enough fluids.

Stones caused by uric acid are also fairly common. These come from a natural substance called purine, which is a byproduct of animal proteins (meat, chicken and fish).

If I have multiple kidney stones, are they all made of the same substances?

The materials that make up a kidney stone can be different. You could develop a calcium oxalate stone and one made of uric acid.

Symptoms and Causes

What causes kidney stones?

Kidney stones are formed from substances in your urine. The substances that combine into stones normally pass through your urinary system. When they don’t, it’s because there isn’t enough urine volume, causing the substances to become highly concentrated and to crystalize. This is typically a result of not drinking enough water. The stone-forming substances are:

These and other chemicals are some of the waste products that exit your body.

What are the symptoms of kidney stones?

You can have a stone in your kidney for years and not know it’s there. But, when it starts to move or becomes very large, you may have symptoms. Symptoms of a kidney stone include:

• Feeling pain in your lower back or side of your body. This pain can start as a dull ache that may come and go. It can also become severe and result in a trip to the emergency room.
• Having nausea and/or vomiting with the pain.
• Seeing blood in your urine.
• Feeling pain when urinating.
• Being unable to urinate.
• Feeling the need to urinate more often.
• Fever or chills.
• Having urine that smells bad or looks cloudy.

Smaller kidney stones may not cause pain or other symptoms. These “silent stones” pass out of your body in your urine.

What are the symptoms of kidney stones in children?

The most common symptoms of kidney stones are blood in the urine or pain. The amount of pain your child experiences and where it hurts depends on where the stone is located and its size. Other symptoms include:

• Severe colicky pain.
• Inability to urinate (when a stone blocks the urinary tract).
• Nausea/vomiting.
• Cloudy, foul-smelling urine, fever, chills or weakness which might be a sign of a serious infection.
• Blood in the urine.

Most pediatric kidney stones remain in the kidney, but up to a third may migrate from the kidney and get stuck in a ureter. Stones that remain in the kidney, although often painless, can be the source of recurrent urinary tract infections. Those that lodge in the ureter can create severe colicky pain.

Diagnosis and Tests

How are kidney stones diagnosed?

Your healthcare provider will discuss your medical history and possibly order some tests. These tests include:

• Imaging tests: An X-ray, CT scan and ultrasound will help your healthcare provider see the size, shape, location and number of your kidney stones. These tests help your provider decide what treatment you need.
• Blood test: A blood test will reveal how well your kidneys are functioning, check for infection and look for biochemical problems that may lead to kidney stones.
• Urine test: This test also looks for signs of infection and examines the levels of the substances that form kidney stones.

Management and Treatment

Kidney stone treatment options

How are kidney stones treated?

Once diagnosed, your healthcare provider will first determine if you even need treatment. Some smaller kidney stones may leave your system when you urinate. This can be very painful. If your provider decides that you do need treatment, your options include medications and surgery.

Medications. Medications may be prescribed to:

• Decrease pain. Your healthcare provider may recommend that you take an over-the-counter medication like ibuprofen or, if you’re in the emergency room, an IV narcotic.
• Manage nausea/vomiting.
• Relax your ureter so that the stones pass. Commonly prescribed medicines include tamsulosin (Flomax®) and nifedipine (Adamant® or Procardia®).

You should ask your healthcare provider before you take ibuprofen. This drug can increase the risk of kidney failure if taken while you’re having an acute attack of kidney stones — especially in those who have a history of kidney disease and associated illnesses such as diabetes, hypertension and obesity.

Surgery. There are four types of surgeries used to treat kidney stones. The first three are minimally invasive, meaning that the surgeon enters your body through a natural opening (like your urethra), or makes a small incision.

• Ureteroscopy: To perform this procedure, a small instrument called an ureteroscope is inserted in your urethra, through your bladder and into a ureter. This instrument shows the kidney stones and then retrieves them in a surgical “basket,” or breaks them apart using a laser. These smaller pieces of the kidney stones are then easily able to exit your body through your urinary tract.
• Shockwave lithotripsy: In this procedure, you’re placed on a special type of surgical table or tub. High-energy shockwaves are sent through water to the stone(s). The shockwaves break apart the stones, which are then more easily able to exit your body.
• Percutaneous nephrolithotomy: When kidney stones can’t be treated by the other procedures — either because there are too many stones, the stones are too large or heavy or because of their location — percutaneous nephrolithotomy is considered. In this procedure, a tube is inserted directly into your kidney through a small incision in your back. Stones are then disintegrated by an ultrasound probe and suctioned out so that you don’t have to pass any fragments. A urethral stent is placed after the procedure (an internal tube from the kidney to the bladder which is removed one week later). Patients are typically kept overnight for observation.
• Open stone surgery: A longer cut is used during this surgery. Compared to minimally invasive procedures, it’s rarely performed (0.3% to 0.7% of cases).

How are children treated for kidney stones?

Most children’s kidney stones can be treated with the shock wave lithotripsy (SWL), a completely non-invasive procedure. Your child is placed under anesthesia and sound waves of specific frequencies are focused on the stones to shatter them into fragments small enough to be easily passed during urination.

How long does it take to pass a kidney stone?

The amount of time it can take for you to pass a kidney stone is different from another’s. A stone that’s smaller than 4 mm (millimeters) may pass within one to two weeks. A stone that’s larger than 4 mm could take about two to three weeks to completely pass.

Once the stone reaches the bladder, it typically passes within a few days, but may take longer, especially in an older man with a large prostate. However, pain may subside even if the stone is still in the ureter, so it’s important to follow up with your healthcare provider if you don’t pass the stone within four to six weeks.

Are there any foods or drinks that help treat kidney stones? Are there any home remedies?

There are three liquids rumored to help with kidney stones:

• Cranberry juice. Although cranberry juice can help prevent urinary tract infections (UTIs), it doesn’t help with kidney stones.
• Apple cider vinegar. Vinegar is acidic and it can sometimes create changes to your urine, which helps with kidney stones. But, this doesn’t always help. Talk to your healthcare provider about the use of vinegar.
• Lemon juice. Lemon juice is rich in citrate, which can help prevent kidney stones from forming. Citrates are found in several citrus fruits including lemons, limes, oranges and melons.
• Coffee. Studies show that coffee may decrease your risk of developing kidney stones.

Avoid soda and other drinks with added sugar or fructose corn syrup. They increase your risk.

Prevention

How can I prevent kidney stones?

There are several ways to decrease your risk of kidney stones, including:

• Drink water. Drink at least six to eight 8-ounce glasses every day (about 64 ounces). Staying hydrated helps you urinate more often, which helps “flush away” the buildup of the substances that cause kidney stones. If you sweat a lot, be sure to drink even more.
• Limit salt. Eat less sodium. You may want to connect with a dietician for help with planning what foods you eat.
• Lose weight. If you’re overweight, try to lose some pounds. Talk to your healthcare provider about an ideal weight.
• Take prescriptions. Your healthcare provider may prescribe some medications that help prevent kidney stones. The type of medication may depend on the type of stones you get.

Should I cut calcium out of my diet if I develop calcium oxalate kidney stones?

If you develop kidney stones composed of calcium, you may be tempted to stop eating foods that include calcium. However, this is the opposite of what you should do. If you have calcium oxalate stones, the most common type, it’s recommended that you have a diet higher in calcium and lower in oxalate.

Foods that are high in calcium include:

• Cow’s milk.
• Yogurt.
• Cheese.
• Broccoli.
• Kale.
• Calcium-fortified juices.
• Dried beans.
• Salmon.
• Calcium-fortified hot cereal.

Foods that are high in oxalates include (reduce these in your diet):

• Spinach.
• Rhubarb.
• Strawberries.
• Tea.
• Dried peas and beans.
• Nuts and nut butters.
• Wheat bran.

It’s also important to drink plenty of fluids to dilute the substances in your urine.

Outlook / Prognosis

What’s the outlook for kidney stones?

The outlook for kidney stones is very positive, although there is a risk of recurrence (the stones coming back). Many kidney stones pass on their own over time without needing treatment. Medications and surgical treatments to remove larger kidney stones are generally very successful and involve little recovery time.

It’s possible to get kidney stones multiple times throughout your life. If you keep developing kidney stones, your healthcare provider may work with you to discover why the stones happen. Once the cause is found, you may be able to make dietary changes to prevent future stones.

Can a large kidney stone cause an injury?

Your risk of injury from a kidney stone can go up based on the size and location of the stone. A larger stone could get stuck in a ureter, causing pressure to build up. This can lead to renal failure and, in the worst-case (but rare) scenario, you could lose your kidney. The chance of passing a 1 cm stone is less than 10%, and stones larger than 1 cm typically don’t pass.

How long does the pain last after you pass a kidney stone?

Pain from a stone can persist for a few days after completely passing. But, if the pain persists beyond a week, a repeated imaging test (usually an ultrasound) is done to see if any further blockage is present (sometimes due to a remaining stone fragment).

Living With

Can I live a normal life with kidney stones?

Kidney stones shouldn’t stop you from going about your daily activities, or drastically reduce your quality of life. Thanks to passing them while you urinate, and thanks to treatment options, kidney stones are not permanent.

Do kidney stones cause kidney disease?

If you’ve had kidney stones, you’re at a higher risk for more kidney stones and chronic kidney disease.

Are kidney stones deadly?

No. Kidney stones do not cause death.

When should I see my healthcare provider?

Don’t hesitate to see your healthcare provider if you’re experiencing symptoms of kidney stones. If you have a kidney stone, you’ll need to know where it’s located and what size it is so that you can get treatment and prevent complications.

When should I go to the emergency department?

Go to the emergency department if the pain is unbearable. You may be prescribed medication for your pain and any nausea/vomiting.

What questions should I ask my healthcare provider?

• Do I have a kidney stone or is there another reason for my symptoms?
• What type of kidney stone do I have?
• What size is my kidney stone?
• Where is my kidney stone located?
• How many kidney stones do I have?
• Do I need treatment or will I be able to pass the kidney stone?
• Should I be tested for kidney disease?
• What changes should I make to my diet?
• What type of procedure should I have to get rid of the stones?

A note from Cleveland Clinic

Kidney stones can be frustrating at best and agonizingly painful at the worst. To stop your situation from getting worse, you should be evaluated by a healthcare provider as soon as possible. The pain can get severe, and surgery might be necessary. Remember: don’t skip your prescriptions, drink lots of water and follow any dietary guidelines. Also, remember that kidney stones are a temporary condition. They won’t bother you forever.

Can Tamsulosin Get That STONE to Drop? – REBEL EM

Background: Ureteric (renal) colic is a common, painful condition encountered in the Emergency Department (ED). Sustained contraction of smooth muscle in the ureter as a kidney stone passes the length of the ureter leads to pain. The majority of stones will pass spontaneously (i.e. without urologic intervention). For over a decade, calcium channel blockers (i.e. nifedipine) and, more commonly, alpha adrenoreceptor antagonists (i.e. tamsulosin) have been employed in the treatment of ureteral colic for their potential ability to increase stone passage, reduce pain medication use and reduce urologic interventions. These interventions were mostly based on poor methodologic studies and meta-analyses of these flawed studies (Hollingsworth 2016)

Over the past 3-4 years, a small number of higher-quality RCTs have been published (Ferre 2009, Pickard 2015, Furyk 2016). These studies have demonstrated a lack of benefit for routine use of alpha blockers. However, secondary outcomes suggest a possible benefit in larger stones (> 6 mm). In spite of recent multiple studies, the use of alpha blockers remains an area of active debate.

Article: Meltzer, AC et al. Effect of Tamsulosin on Passage of Symptomatic Ureteral Stones: A Randomized Clinical Trial. JAMA Intern Med 2018 PMID: 29913020

Clinical Question: Is tamsulosin effective in facilitating the ureteral stone expulsion in ED patients presenting with stones < 9 mm in diameter?

Population: Adults > 18 years of age presenting to the ED with a symptomatic urinary stone determined by computed tomography (CT) to be < 9 m in diameter and located in the ureter.

Outcomes:

• Primary: Stone passage based on visualization or capture by day 28
• Secondary: Stone passed on follow up CT scan, Crossover to open-label tamsulosin, time to stone passage, return to work, use of analgesic medication, hospitalization, surgical intervention and repeated ED visit for urinary stones

Intervention: Tamsulosin 0. 4 mg q24

Control: Matched placebo

Design: Multicenter, randomized, double-blind, placebo-controlled study

Excluded: Patients requiring/desiring immediate surgical management, UTI, Prior GU surgery, pregnant patients, breastfeeding mothers, prior tamsulosin hypersensitivity, current use of alpha-blockers or calcium channel blockers, current use of steroids, stone > 9 mm, prior treatment for current ureteral stone, use of vardenafil (contraindication to tamsulosin), known renal insufficiency, fever > 101.5, floppy iris syndrome, planned cataract surgery within 60 days, prisoners, prior enrollment in study

Primary Results

• 512 patients randomized
  • 267 patients to tamsulosin
  • 245 patients to placebo
• 15 patients lost to follow up
• Stone Size
  • Mean diameter of symptomatic urinary stone was 3.8mm
  • 26% of stones > 5 mm

Critical Findings:

• Stone passage as reported by patient (Primary Outcome)
  • Tamsulosin 49. 6% vs. placebo 47.3%
  • Relative Risk: 1.05 (95% CI 0.87 – 1.27)
  • No statistically significant difference
• There was no significant difference in any of the secondary outcomes
• Passage based on symptomatic stone size (preplanned subgroup analysis)
  • No statistically significant difference

• Adverse events
  • There was more dizziness amongst patients receiving tamsulosin
  • Amongst males, there was a significantly higher rate of abnormalities with ejaculation in the tamuslosin arm (18.2% vs 7.4%)

Strengths:

• Asks a clinically important, patient centered question
• Multicenter study
• Largest RCT to date on this topic
• Randomization and blinding appropriately performed
• Study was well protected against the risk of bias (i.e. concealed allocation, masking of patients, study personnel, and outcome assessors, intention-to-treat analysis, and near complete follow-up)
• A pre-planned exploratory analysis of subgroups was also performed including size of stone and location of stone in the ureter
• Baseline characteristics were similar between groups including stone size
• Enrolled participants with stones in any part of the ureter to increase generalizability of study
• Study in 2 phases. Phase 1 (single-center) was used to determine passage rate at 28 days in placebo arm in order to establish a target sample size to find a 15% absolute increase in primary outcome in the tamsulosin arm
• Follow up to stone passage at 28 days (primary outcome) was excellent. Less than 3% of patients were lost
• Almost 50% of patients (238/512) underwent repeat CT scanning at 28 days to assess for stone passage

Limitations:

• The study only included patients with CT confirmed ureteral stones. This may exclude a large group of patients in whom ureteral colic was clinically suspected and the provider did not deem a CT was necessary
• Study enrollment only available certain hours of the day (ranged from 60-116 hours of availability/week depending on site)
• While most baseline characteristics were similar, some were not. More patients in the placebo arm had multiple stones, more patients in the tamsulosin arm had distal ureteral stones
• Patients lost to follow up were excluded from the analysis. Instead, investigators could have included them with outcomes matching the null-hypothesis
• Target absolute difference may have been set too high. A smaller but still clinically important difference may still be possible
• Self-reported adherence to study medication was 82.9% by day 15 and 72.9% by day 28.  ≈20% of study population was not using medication at 2 weeks
• In cases in which there is more than one stone noted on the CT scan, the physician treating the patient will determine the likely location and dimensions of the stone causing symptoms by reviewing the patient’s ED record.
• Most stones were small (75% < 5 mm)

Discussion:

• The majority of patients (≈75%) in this study had stones < 5 mm.  A recent RDCT of ≈ 3300 patients with distal ureteral stones randomized to tamsulosin vs placebo for 4 weeks. 2/3rds of the enrolled patients had stones > 5mm in size.  A higher rate of stone passage was seen with tamsulosin (86% vs 79%) for distal ureteral stones.   In a subgroup analysis stones >5mm also showed statistically significant benefit with tamsulosin (85.6% vs 74.5%; OR 2.05; 95% CI 1.65 – 2.54). (Ye 2017)
• It is important to note that the idea that larger stones will benefit is based on secondary and exploratory analyses only. Additionally, the Ye article is limited as only distal ureteral stones were included. A RDCT primarily examining larger stones is needed.
• Even if larger stones will benefit from tamsulosin, the application of this information is limited as it would require us to return to a “CT all ureteral colic patients” approach to management. This would increase radiation exposure and resource utilization with only a small portion of patients benefiting.

Authors Conclusions:

“Tamsulosin did not significantly increase the stone passage rate compared with placebo. Our findings do not support the use of tamsulosin for symptomatic urinary stones smaller than 9 mm. Guidelines for medical expulsive therapy for urinary stones may need to be revised. ”

Our Conclusions: We agree with the authors conclusions. This well-done, RDCT did not demonstrate an advantage to medical expulsion therapy with tamsulosin in comparison to placebo at 28 days.

Potential to Impact Current Practice: Current urology guidelines recommend the addition of tamuslosin in the treatment of ureteral colic mainly based on poor quality studies and systematic reviews and meta-analyses including these poorly done studies. This study adds to the growing, high-quality evidence that tamsulosin offers no significant benefit and further challenges current practices.

Bottom Line: Tamsulosin should not routinely be prescribed to patients with ureteral colic and, at this point, it is unclear if there is any subgroup that may benefit. There will be continued conjecture that larger stones may benefit due to inconsistency in the literature and the absence of a RDCT primarily looking at passage of larger stones.

Read More:

References: 

1. Hollingsworth JM et al. Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis. BMJ 2016. PMID: 27908918
2. Al-Ansari et al. Efficacy of Tamsulosin in the Management of Lower Ureteral Stones: A Randomized Double-blind Placebo-controlled Study of 100 Patients. Urology 2010; 75: 4-8. PMID: 20109697
3. Ferre RM et al. Tamsulosin for Ureteral Stones in the ED: a Randomized, Controlled Trial. Ann of EM 2009; 54: 432-9. PMID: 19200622
4. Furyk JS et al. Distal ureteric stones and tamsulosin: a double-blind, placebo-controlled, randomized, multicenter trial. Ann Emerg Med 2016; 67(1): 86-95. PMID: 26194935
5. Hermanns T et al. Is There a Role for Tamsulosin in the Treatment of Distal Ureteral Stones of 7 mm or less? Results of Randomised, Double-Blind, Placebo-Controlled Trial. European Urology 2009; 56(3): 407-12. PMID: 19375849
6. Picard R et al. Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial. Lancet 2015; 386(9991): 341-9. PMID: 25998582
7. Segura JW et al. The American Urological Association. Ureteral Stones Clinical Guidelines Panel summary report on the management of ureteral calculi. J Urol. 1997;158(5):1915-1921. PMID: 9334635
8. Singh A et al. A Systemic Review of Medical Therapy to Facilitate Passage of Ureteral Calculi. Ann of EM 2007; 50: 552-63. PMID: 17681643
9. Vincendeau S et al. Tamsulosin hydrochloride vs Placebo for Management of Distal Ureteral Stones. Arch Intern Med 2010; 170(22): 2021-7. PMID: 21149761
10. Ye Z et al. Efficacy and safety of tamsulosin in medical expulsion therapy for distal ureteral stones with renal colic: a multicenter, randomized, double-blind, placebo-controlled trial. Eur Urol 2017. PMID: 29137830

Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie)

Cite this article as: Anand Swaminathan, “Can Tamsulosin Get That STONE to Drop?”, REBEL EM blog, June 29, 2018. Available at: https://rebelem.com/can-tamsulosin-get-that-stone-to-drop/.The following two tabs change content below.

REBEL EM Associate Editor and Author

Facts About Flomax (Tamsulosin) and Flomax Generics

Flomax (tamsulosin hydrochloride) is a drug used to treat an enlarged prostate and chronic prostate inflammation. It is one of the most commonly prescribed drugs in older men and one of the 200 most prescribed drugs overall, according to the Pharmacy Technician Certification Board.

Flomax was granted approval by the U.S. Food and Drug Administration (FDA) in 1997. In 2009, the drug manufacturer Boehringer Ingelheim lost its patent for the drug molecule, and, as a result, there are numerous low-cost generics now available.

Science Photo Library/Getty Images 

Indications

Flomax belongs to a class of medications known as alpha-adrenergic blockers that work by relaxing both the bladder neck muscles and the muscle of the prostate gland itself.  By doing so, men with prostate problems are able to urinate more freely, reduce the need for nighttime urination (nocturia), and improve urinary urgency and frequency.

Flomax is indicated to treat a number of common medical conditions in men, including:

Despite the fact that Flomax can decrease blood pressure, it is not approved for the treatment of hypertension (high blood pressure).

Dosage

Flomax is available in a 0.4-milligram (mg) capsule. It is taken daily approximately 30 minutes after a meal, ideally at the same time every day.

The effects of the drug can usually be felt within the first 48 hours. Complete urinary relief may take up to two to six weeks. If a 0.4-mg dose is unable to provide relief, your healthcare provider may recommend that you double the dose to 0.8 mg once daily. Never increase the dose unless directed to do so by your healthcare provider.

If you miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and proceed as usual. Never take a double dose of Flomax, since this could lead to a steep drop in blood pressure (hypotension).

Many urologists today will prescribe Flomax as part of a dual therapy. A 2019 meta-analysis found that the combination of tamsulosin plus Avodart (dutasteride) provides greater therapeutic effect for BPH. The combination has a higher incidence of sexual side effects, but can markedly reduce risk of BPH-related symptom progression and acute urinary retention relative to tamsulosin monotherapy.

In 2010, a combination drug called Jalyn (dutasteride 0.5 mg/tamsulosin 0.4 mg) was granted approval by the FDA.

Common Side Effects

While Flomax is considered safe to use over the long term, there are a number of side effects to be aware of. The most common include (by frequency of occurrence):

• Headaches
• Dizziness
• Rhinitis (hay fever)
• Ejaculation problems (including retrograde ejaculation)
• Abnormal weakness
• Chest pain
• Cough
• Drowsiness
• Nausea
• Decreased libido
• Blurred vision
• Rash
• Priapism (a painful erection lasting four hours or more)

Other more problematic side effects include dizziness, vertigo, postural hypotension (low blood pressure when rising), and fainting. Collectively known as orthostasis, these symptoms tend to occur within the first eight weeks of treatment. Due to its potential effect on blood pressure, people with low blood pressure, mechanical heart problems, or congestive heart failure should be monitored closely while taking Flomax.

Flomax may take up to 2-6 weeks to provide benefit. Call your healthcare provider if your urination doesn’t improve within two weeks or you experience any severe, persistent, or worsening side effects, including rash, priapism, or fainting.

Interactions and Contraindications

Flomax is contraindicated for use in persons with a known allergy to Flomax or any of its components.

Flomax should not be used with certain CYP3A4 inhibitors. These are drugs that block the CYP3A4 enzyme, a substance produced by the liver that can affect the bioavailability (concentration) of Flomax in the blood. Taking a strong CYP3A4 inhibitor may increase the bioavailability of Flomax and the severity of side effects (most typically low blood pressure).

In some cases, your blood pressure may need to be monitored while on treatment. In others, one of the two drugs may need to be substituted.

Speak with your healthcare provider if you take any of the following:

• Alpha-blockers, used to treat high blood pressure, including (Cardura) doxazosin, Dibenzyline (phenoxybenzamine), and Minipress (prazosin)
• Anti-arrhythmia drugs like Multaq (dronedarone) and Nexterone (amiodarone)
• Antibiotics like Amoxil (amoxicillin), (Biaxin) clarithromycin, and Ketek (telithromycin)
• Antifungal drugs like itraconazole, ketoconazole, omeprazole, lansoprazole, and voriconazole
• Anti-tuberculosis drugs like isoniazid and rifampin
• Darvon (propoxyphene), an opioid pain reliever
• Erectile dysfunction drugs like Viagra (sildenafil), Cialis (tadalafil), and Levitra (vardenafil)
• HIV protease inhibitors such as Reyataz (atazanavir), Prezista (darunavir), and Kaletra (lopinavir/ritonavir)
• Qualaquin (quinine), used to treat malaria
• Ranexa (ranolazine), used to treat angina
• Serzone (nefazodone), an antidepressant
• Varubi (rolapitant), used to treat chemotherapy-related nausea
• Viekira Pak (ombitasvir/paritaprevir/ritonavir/telaprevir), used to treat hepatitis C

Flomax should not be used in people with end-stage kidney failure. People with kidney impairment should also be regularly monitored due to increased risk of an exaggerated hypotensive response.

If you are scheduled to have cataract or glaucoma surgery, tell your healthcare provider if you are either using or have recently used Flomax. A serious eye disorder called intraoperative floppy iris syndrome has been known to occur in around 2% of those who have undergone cataract surgery while on Flomax.

As such, Flomax is not recommended for use prior to cataract surgery due to studies showing an increased risk of a detached retina or lost lens.

Considerations

Flomax is not indicated for use in women. Due to its potential impact on blood pressure, it is important to advise your healthcare provider if you have dizziness while taking Flomax. Take care when rising from bed in the morning to avoid falling or blacking out. The same applies if you are planning to drive given the risk of vision impairment and dizziness. In some cases, treatment may need to be stopped if the drug interferes with your ability to function normally.

Because BPH closely resembles prostate cancer, men with prostate problems should undergo tests to rule out cancer before starting treatment and at regular intervals afterward.

Generics and Payment Assistance

Following the end of Boehringer Ingelheim’s patent exclusivity in 2009, the FDA approved the first Flomax generic in March 2010. Today, there are 11 tamsulosin 0.4-mg generics available in the United States, ranging in price from $10 to $30 for a 30-day supply.

For its part, Boehringer Ingelheim offers the brand name Flomax at an online price of $35 for 30 capsules or $90 for 90 capsules with free home delivery.

Meanwhile, users of Jalyn who qualify can enroll with the GlaxoSmithKline’s GSKForU Patient Assistance Program to obtain the drug at a low to no cost. If you live in the United States, have no insurance drug benefit, and meet certain income requirements, you may be eligible. The current monthly retail price of Jalyn is between $120 and $250.

Extracorporeal lithotripsy

Extracorporeal shock wave lithotripsy or ESWL is a non-surgical method of destroying stones in the urinary system using directional ultrasonic waves. Lithotripsy (from the Greek lithos – “stone” and tribo – “to crush”) literally translates as “stone crushing”. The impulses freely penetrate the surrounding tissues, and the energy transfer is carried out only in the focus area – the “working spot”. This causes a gradual “loosening” and destruction of the crystal lattice of a kidney stone or other.
As a result of such treatment of the disease, one large stone disintegrates into a number of smaller fragments that can be naturally excreted in the urine stream. The cost of treating the disease with kidney lithotripsy is much lower than surgery, and its effectiveness can be very high.

Equipment for lithotripsy

We use the latest equipment for the treatment procedure.Dornier Gemini is a multifunctional urological complex that provides the technical capabilities for any urological, transcutaneous and endoscopic procedures.

The Dornier Gemini urology unit combines the following equipment and components:

• lithotripter Dornier – percutaneous shock wave therapy unit

• X-ray and ultrasound imaging equipment

• C-pillar – arc

• endoscopy equipment rack

• multifunctional motorized patient table

• computer control center UIMS

The Dornier lithotripter is used for the percutaneous treatment of urolithiasis.The generator of electromagnetic shock waves EMSE, with a wave penetration depth of up to 170 mm, is located on a special movable therapy head, which provides a three-dimensional effect of waves on the calculus. It is a patented technology with proven benefits:

• reduces the time of lithotripsy

• has a minimal level of side effects

• minimizes the likelihood of re-treatment

Indications for the treatment of extracorporeal lithotripsy of urolithiasis:

• the presence of stones in the urinary tract or kidneys from 0. 5 to 2 cm

• the ability to visualize kidney stones

• renal colic, which is caused by kidney stones

Contraindications for the treatment of remote lithotripsy of urolithiasis:

• acute inflammatory, purulent processes in the body

• pregnancy

• bleeding disorder

• menstruation

• obesity 3-4 degrees

• decompensation of concomitant diseases

• serious cardiac abnormalities

• kidney tumor

The effectiveness of treatment by crushing stones by ultrasound in the kidneys and ureter

It is important to understand that lithotripsy does not cure urolithiasis, but only destroys the existing stone.For further treatment of the disease, it is necessary to constantly consult with a urologist on the prevention of kidney and urinary tract stones.

A number of parameters affect the effectiveness of the treatment of the disease:

• absence or presence of obstruction (blockage) of the urinary tract

• the patient’s body weight (if you are overweight, the effectiveness of the procedure may be reduced)

• chemical composition of a kidney or urinary tract stone, indicators of its density

• the presence of an infection in the urinary tract, etc.etc.

How is the distance lithotripsy treatment performed at the Grand Medica clinic?

• It is painless. During the procedure, anesthesia is performed – local or intravenous. The choice of anesthesia is discussed in consultation with a doctor.

• Under visual control. With the help of ultrasound guidance, the localization of the stone in the kidneys or urinary tract is determined. Throughout the entire process, the doctor monitors the kidney stone using the monitor of the device.

• Safely. The device creates shock waves that gradually destroy the stone. The procedure is stopped when the stone is sized to pass through the ureter and urethra. During the procedure, anesthesia is performed – local or intravenous. The choice of anesthesia is discussed in consultation with a doctor.

What is included in the cost of the procedure?

The cost of treatment depends on the complexity of the operation (the size of kidney or urinary tract stones, location, their number, the presence of concomitant diseases).Everything is determined by the doctor after collecting anamnesis and diagnostic results. The final cost of treating the disease includes lithotripsy, consultation with an anesthesiologist, anesthetic aid (if anesthesia is available), hospital stay, treatment and nutrition.

Do I need special preparation for lithotripsy?

No special training is required. In the presence of a pronounced inflammatory process of the urinary tract, antibiotic therapy is performed before the procedure.

Do you need additional diagnostics before lithotripsy?

Before hospitalization, it is necessary to consult a urologist (with ultrasound) and perform a standard examination:

• clinical blood test

• general urine analysis

• biochemical blood test (urea, creatinine, total bilirubin, glucose)

• coagulogram (INR, prothrombin, APTT)

• blood test for HIV, RW, HBsAg, HCV

• blood test for group, Rh factor and antibodies to Rh factor with phenotyping

• ECG

• chest x-ray

• may require computed tomography or plain intravenous urography

If there is evidence of the need for additional diagnostics, the doctor will inform you at a consultation.

Is it always necessary to stay in the hospital for the whole day?

After lithotripsy without anesthesia, in some cases (depending on the position and size of kidney or urinary tract stones), the patient can independently leave the hospital after 3-4 hours.

Are there any side effects after the procedure?

Despite the fact that crushing stones in the kidneys or urinary tract is a low-traumatic technique, after ESWL, frequent urination, mild sting, and pain are possible.Sometimes there is blood in the urine, and a slight increase in temperature is also possible. This is due to the fact that kidney stones turn into “sand” and are excreted in a natural way, which also happens when stones in the urinary tract are broken up.

Postoperative rehabilitation treatment

After the procedure, according to indications, antispasmodics and analgesics are prescribed. It is possible to take antibiotics for the prevention of infectious diseases of the genitourinary system.

It is important to consume at least 1.5 liters of fluid per day to facilitate the release of “sand” after crushing kidney or urinary tract stones.

When you are discharged, you will receive detailed instructions and the surgeon’s mobile phone number, which you can use to contact the doctor around the clock.

You can make an appointment with a specialist daily by phone: 8 (3843) 99-40-40 or leave a request on the clinic’s website.

Treatment of urolithiasis

Options for surgical treatment of urolithiasis is determined by a urologist and depends on the results of laboratory and instrumental diagnostic methods (ultrasound, urography, MSCT).

Surgical treatment of kidney stones:

• Remote shock wave lithotripsy.

• Endoscopic contact lithotripsy of kidney stones using special flexible endoscopes.

• Percutaneous lithotripsy.

Indications for surgical treatment of ureteral stones

• large calculi that have a low likelihood of spontaneous passage

• recurrent bouts of renal colic on the side of the stone, despite adequately prescribed treatment

• persisting according to the results of ultrasound examination of the violation of the outflow of urine from the kidney on the side of the calculus

• renal failure, solitary kidney

• no effect of stone-exorcising treatment

Contraindications to surgical treatment of ureteral stones

• urinary tract infection

• large prostate adenoma in men

Indications for surgical treatment of kidney stones:

• large calculi

• recurrent bouts of renal colic on the side of the stone, despite adequately prescribed treatment

• persisting according to the results of ultrasound examination of the violation of the outflow of urine from the kidney on the side of the calculus

• no effect of stone-destructive treatment

Contraindications for surgical treatment of kidney stones

• urinary tract infection

• malignant tumor of the kidney

• tumor process in the area of ​​the proposed surgical access

• atypical location of the intestine, which makes it impossible to access the kidney

Preoperative preparation of a patient for surgical treatment is carried out in a urological hospital and has no specificity in comparison with other types of surgical interventions. With an existing urinary tract infection, a course of antibiotic therapy is prescribed before the operation, taking into account the bacteriological analysis of urine, which continues in the postoperative period and after the patient is discharged. In order to prevent life-threatening conditions, compression of the lower extremities is prescribed during the operation.

Surgical treatment of ureteral stones

Extracorporeal shock wave lithotripsy

Extracorporeal shock wave lithotripsy or ESWL is a non-surgical method of destroying stones in the urinary system using directional ultrasonic waves.Lithotripsy (from the Greek lithos – “stone” and tribo – “to crush”) literally translates as “stone crushing”. The impulses freely penetrate the surrounding tissues, and the energy transfer is carried out only in the focus area – the “working spot”. This causes a gradual “loosening” and destruction of the crystal lattice of a kidney stone or other.

As a result of such treatment of the disease, one large stone disintegrates into a number of smaller fragments that can be naturally excreted in the urine stream.The cost of treating the disease with kidney lithotripsy is much lower than surgery, and its effectiveness can be very high.

Lithotripsy equipment

We use the latest equipment for the treatment procedure. Dornier Gemini is a multifunctional urological complex that provides the technical capabilities for any urological, transcutaneous and endoscopic procedures.

The Dornier Gemini urology unit combines the following equipment and components:

• lithotripter Dornier – percutaneous shock wave therapy unit

• X-ray and ultrasound imaging equipment

• C-pillar – arc

• endoscopy equipment rack

• multifunctional motorized patient table

• computer control center UIMS

The Dornier lithotripter is used for the percutaneous treatment of urolithiasis. The generator of electromagnetic shock waves EMSE, with a wave penetration depth of up to 170 mm, is located on a special movable therapy head, which provides a three-dimensional effect of waves on the calculus. It is a patented technology with proven benefits:

• reduces the time of lithotripsy

• has a minimal level of side effects

• minimizes the likelihood of re-treatment

Indications for the treatment of extracorporeal lithotripsy of urolithiasis:

• the presence of stones in the urinary tract or kidneys from 0.5 to 2 cm

• the ability to visualize kidney stones

• renal colic, which is caused by kidney stones

Contraindications for the treatment of remote lithotripsy of urolithiasis:

• acute inflammatory, purulent processes in the body

• pregnancy

• bleeding disorder

• menstruation

• obesity 3-4 degrees

• decompensation of concomitant diseases

• serious cardiac abnormalities

• kidney tumor

The effectiveness of treatment by crushing stones by ultrasound in the kidneys and ureter

It is important to understand that lithotripsy does not cure urolithiasis, but only destroys the existing stone. For further treatment of the disease, it is necessary to constantly consult with a urologist on the prevention of kidney and urinary tract stones.

A number of parameters affect the effectiveness of the treatment of the disease:

• absence or presence of obstruction (blockage) of the urinary tract

• the patient’s body weight (if you are overweight, the effectiveness of the procedure may be reduced)

• chemical composition of a kidney or urinary tract stone, indicators of its density

• the presence of an infection in the urinary tract, etc.etc.

How is the distance lithotripsy treatment performed at the Medica Medical Clinical Center?

• It is painless. During the procedure, anesthesia is performed – local or intravenous. The choice of anesthesia is discussed in consultation with a doctor.

• Under visual control. With the help of ultrasound guidance, the localization of the stone in the kidneys or urinary tract is determined.Throughout the entire process, the doctor monitors the kidney stone using the monitor of the device.

• Safely. The device creates shock waves that gradually destroy the stone. The procedure is stopped when the stone is sized to pass through the ureter and urethra. During the procedure, anesthesia is performed – local or intravenous. The choice of anesthesia is discussed in consultation with a doctor.

What is included in the cost of the procedure?

The cost of treatment depends on the complexity of the operation (the size of kidney or urinary tract stones, location, their number, the presence of concomitant diseases).Everything is determined by the doctor after collecting anamnesis and diagnostic results. The final cost of treating the disease includes lithotripsy, consultation with an anesthesiologist, anesthetic aid (if anesthesia is available), hospital stay, treatment and nutrition.

Do I need special preparation for lithotripsy?

No special training is required. In the presence of a pronounced inflammatory process of the urinary tract, antibiotic therapy is performed before the procedure.

Is additional diagnostics required before lithotripsy?

Before hospitalization, it is necessary to consult a urologist (with ultrasound) and perform a standard examination:

• clinical blood test

• general urine analysis

• biochemical blood test (urea, creatinine, total bilirubin, glucose)

• coagulogram (INR, prothrombin, APTT)

• blood test for HIV, RW, HBsAg, HCV

• blood test for group, Rh factor and antibodies to Rh factor with phenotyping

• ECG

• chest x-ray

• may require computed tomography or plain intravenous urography

If there is evidence of the need for additional diagnostics, the doctor will inform you at a consultation.

Is it always necessary to stay in the hospital for the whole day?

After lithotripsy without anesthesia, in some cases (depending on the position and size of kidney or urinary tract stones), the patient can independently leave the hospital after 3-4 hours.

Are there any side effects after the procedure?

Despite the fact that crushing stones in the kidneys or urinary tract is a low-traumatic technique, after ESWL, frequent urination, mild sting, and pain are possible.Sometimes there is blood in the urine, and a slight increase in temperature is also possible. This is due to the fact that kidney stones turn into “sand” and are excreted in a natural way, which also happens when stones in the urinary tract are broken up.

Postoperative rehabilitation treatment

After the procedure, according to indications, antispasmodics and analgesics are prescribed. It is possible to take antibiotics for the prevention of infectious diseases of the genitourinary system.

It is important to consume at least 1.5 liters of fluid per day to facilitate the release of “sand” after crushing kidney or urinary tract stones.

When you are discharged, you will receive detailed instructions and the surgeon’s mobile phone number, which you can use to contact the doctor around the clock.

Endoscopic contact lithotripsy

This method of surgical treatment consists in carrying out special endoscopic equipment through the urethra into the ureter, visualizing the calculus and crushing it using various energy options – Laser; pneumatic and electro-pulse.Fragments of calculus are removed under constant visual control.

Clinical study Kidney stones: silodosin, Extracorporeal shock wave lithotripsy, Tamsulosin – Clinical trial registry

Use of phytopreparations based on terpenes in urolithiasis

One of the most common urological diseases is urolithiasis.The absolute number of registered patients with urolithiasis in the Russian Federation has been constantly increasing since 2002 and amounted to 713,397 people in 2008. Overall, the increase was 13.3%. The indicator of the number of registered patients per 100,000 population from 2002 to 2004. also increased from 440.5 to 463.7, decreased slightly in 2005 (to 462.7), and then increased again, reaching 502.4 in 2008 (+ 14.0% over 7 years) [1] …

The maximum rate of incidence of urolithiasis per 100,000 population in 2008was noted in the Far Eastern Federal District (580.0), and the minimum in the Southern Federal District (409.6). By region, the maximum incidence rates of urolithiasis per 100,000 population were noted in the Altai Territory (1216.2) and in the Nenets Autonomous Okrug (992.4), and the lowest in the Jewish Autonomous Region (207. 5) and the Karachay-Cherkess Republic (211, 7) [1].

Such a large number of patients is due to the fact that urolithiasis affects patients of almost any age, from infants to the elderly.The largest percentage of patients are people of middle age from 20 to 40 years, i.e. the most able-bodied and socially active [2].

History of drug use

In order to expel calculi from the kidneys and ureters in urology, various drugs are used, mainly antispasmodics, calcium channel blockers, alpha-blockers, as well as corticosteroids, hormones and prostaglandin synthetase inhibitors [3].

In the treatment of urolithiasis, phytotherapy with essential oils and / or terpenes has long been used.One of the drugs, which is based on a special combination of terpenes, is Rovatinex, and it is this composition that makes the drug unique as an adjuvant therapy for urolithiasis (renal and / or ureteral stones) [4]. Rovatinex is also effective in the presence of a disease-associated inflammatory process in the urinary tract [5], as well as to accelerate the excretion of calculi from the kidneys after extracorporeal lithotripsy [6]. Rovatinex has a 50-year history of application in more than sixty countries of the world [7, 8, 9].

The first clinical and preclinical trials of Rovatinex date back to 1954 and 1956 [10]. Since then, improved expulsion of calculi and the preventive effect of Rovatinex in relation to stone formation have been demonstrated in animal models of nephrocalcinosis [10, 11, 12], as well as in clinical studies and are reflected in reports. Currently published studies, carried out in vitro and in animal models, indicate that Rovatinex has an anti-lithogenic, antibacterial, anti-inflammatory, antispasmodic and analgesic effect, mainly due to ingredients of the terpene class [13], and also has a positive effect on the course of acute and chronic conditions associated with the corresponding diseases of the genitourinary tract.

In the USSR, Rovatinex was supplied in limited quantities, mainly to the 4th Department of the Ministry of Health, or was acquired by patients independently abroad. In 2008, Rovatinex was registered in Russia (reg. No. LSR 006862/08) and has been on the market since July 2010 in the form of enteric gelatin capsules (previously it was produced in the form of drops).

Place of Rovatinex in ICD treatment

Rovatinex (Rowatinex, ROWA PHARMACEUTIKALS Ltd., Ireland) is a herbal preparation based on essential oils containing various terpenes [11], which has a triple action: litholytic, antispasmodic and diuretic. Essential oils are obtained from coniferous trees.

Mechanism of action of Rovatinex:

• has an antispasmodic effect, promotes the passage of stones through the urinary tract, reduces pain in renal and ureteral colic, increases renal blood flow, improves kidney function and increases urine output;
• contributes to the improvement of urodynamics in the upper urinary tract and faster discharge of stones or fragments and sand after their destruction with the help of ESWL (extracorporeal shock wave lithotripsy) or other method;
• has anti-inflammatory, antimicrobial action against a variety of gram-positive and gram-negative microorganisms;
• increases the content of protective colloids in the urine and the content of glucuronic acid in the urine;
• has a pronounced preventive effect, preventing the formation of new stones;
• contains naturally occurring, naturally occurring fat-soluble terpenes that are excreted in the urine.

Indications for the use of Rovatinex:

1. Prevention of ICD.
2. Prevention of recurrence of stone formation after surgery for ICD, including extracorporeal lithotripsy.
3. Conservative treatment of kidney stones against the background of basic drug therapy.
4. Renal colic (under the strict supervision of a urologist and against the background of basic therapy).
5. Chronic inflammatory diseases of the urinary tract outside the period of exacerbation.
6. At the stage of follow-up treatment of acute inflammatory diseases of the urinary tract.

Application features of Rovatinex

Rovatinex is not recommended for use in patients with severe intractable renal colic, anuria, severe urinary tract infection. During treatment, it is necessary to increase fluid intake.

The drug should be used with caution in patients taking anticoagulants.

There is no data on the incompatibility of Rovatinex with other medicinal products. The drug does not affect the ability to drive vehicles. The drug is not recommended to be prescribed in the first trimester of pregnancy and during lactation. Can be used in children from 6 years of age.

Usually, adults and children over 14 years of age are prescribed 1-2 capsules 3 times / day. With renal colic, the dose can be increased to 2-3 capsules 4-5 times / day. For children aged 6-14 years, the drug is prescribed 1 capsule 2 times / day.

Of the contraindications, only children under 6 years of age and individual intolerance to the drug can be distinguished. Side effects are minimal.

Clinical summary

In the period from 1954 to 1998, abroad (Czech Republic, France, Germany, Hungary, Israel, Italy, Poland, Japan and Venezuela), clinical trials of the drug Rovatinex were actively carried out [8, 9, 14, 15]. The total number of research participants exceeded 1500 people.

Most of the patients in these studies had calculi in the kidneys or ureters.The main criterion for evaluating the effectiveness of Rovatinex was the elimination of stones, established by monitoring the urinary tract and / or radiological examination at various times after the end of treatment. Additional evaluation criteria were antispasmodic and antibacterial properties of the drug. In almost all studies, CBC and urine tests were performed before, during, and after the tests. The effect of Rovatinex has been studied in patients with ureteral stones who have not undergone any surgical interventions, and in patients with kidney stones after extracorporeal lithotripsy [14].Summarizing the results of these studies, the scientists found that 825 people were free of stones, which far exceeded their expectations.

A prospective, double-blind, controlled study was conducted by Mukamel E. et al. To study the use of Rovatinex in patients with ureteral stones larger than 3 mm. Authors of is
followings note a significantly higher rate of stone passage in the group of patients taking Rovatinex compared with the placebo group (78% and 52%, respectively) [15].

In 2010, a randomized placebo-controlled study of the use of drugs based on a terpene combination for urolithiasis was conducted in Hungary at the Department of Urology, Semmelweis University (Budapest). The study involved 222 people with an average kidney stone size of 0.3-2.0 cm who underwent SWL. The patients were divided into two groups, comparable in age, size and number of stones, and treatment methods. Patients in group A took Rovatinex, and group B took placebo.The course of treatment lasted 12 weeks. In 67.9% of patients in group A, stones had recovered, compared with 50% of patients in group B [16].

A randomized clinical study on the use of Rovatinex in patients after SWL was conducted by Indian scientists under the leadership of Djaladat H. in 2009. The results indicate a possible acceleration of stone passage when using this drug within 2 weeks after SWL [17].

Pricop C. et al. Studied the effect of selective alpha-blockers on spontaneous passage of stones in the intramural ureter.The authors noted that the use of Rovatinex against the background of therapy with alpha-blockers increases the number of cases of stone passage within 5-10 days from the start of treatment [18].

In the Soviet Union, Rovatinex was used by Professor MD JavadZade [20], who performed treatment with Rovatinex in 12 patients with ureteral stones. The calculi recovered in 8 people, as a result of which it was concluded that the use of Rovatinex was effective in patients with KSD [20].

Currently, in Russia, a clinical study of the effectiveness of the drug Rovatinex in the treatment of patients with nephrolithiasis has been completed, carried out on the basis of the Department of Urology and Nephrology, GOU VPO Altai State Medical University, St.Barnaul (head of the department, professor A.I.Neymark). The study involved 20 patients with kidney stones, who were divided into two groups taking Rovatinex against the background of conventional stone-expelling therapy and not taking Rovatinex. The average size of calculi was 0.4-0.5 cm. Patient groups were comparable in terms of the main parameters (age, size and location of stones, etc.). In the group of patients taking Rovatinex, stone discharge was noted in 70% of cases versus 40% in the group who did not take Rovatinex.The data of this study will be published in the materials of the ROU Plenum in 2011.

The study of the results of the use of the drug Rovatinex in patients with urolithiasis was carried out in 2010-2011. at the Research Institute of Urology (Moscow). The study included 30 patients with various clinical forms of urolithiasis. 15 patients received the drug in the form of enteric-soluble capsules, the remaining 15 people made up the control group. The following clinical properties of the drug Rovatinex were studied: lithokinetic effect, antispasmodic properties and reduction of pain in renal colic caused by kidney and ureteral stones, as well as anti-inflammatory and antimicrobial action.These properties made it possible to use the drug for the complex treatment of patients suffering from urolithiasis complicated by chronic pyelonephritis, in patients with renal colic and in patients with small kidney stones, as well as those who underwent remote lithotripsy of kidney and ureteral stones.

The criteria for inclusion in the study were: men and women aged 18-80 years (residents of Moscow and the Moscow region), the presence of kidney and ureteral stones, the presence of small kidney stones, the presence of chronic pyelonephritis.The exclusion criteria were: children under 6 years of age, patients simultaneously taking oral anticoagulants and drugs that are predominantly metabolized in the liver, I trimester of pregnancy and lactation, severe renal colic, anuria or severe urinary tract infection, contraindications to DLT and other surgical procedures. interventions to remove stones of the kidneys and ureters, individual intolerance to the components of the drug.

Before starting the use of Rovatinex, all patients were examined according to the following plan: consultation with a urologist, general clinical urine analysis, biochemical analysis of blood and urine, plain urography, ultrasound examination of the kidneys and bladder, urine culture with determination of antibiotic sensitivity.

After 18-20 days, a comparison was made between the results of studies performed before the start of taking the drug, with an assessment of the degree of cleansing of the kidneys and ureters from calculi or their fragments and the severity of pain syndrome, clinical examinations, ultrasound examination of the kidneys and bladder in patients of both groups.

The drug was taken before meals. Prescribed 2 capsules 3 times a day. In renal colic, the dose was increased to 2-3 capsules 4-5 times a day for 18-20 days.

The criteria for evaluating the effectiveness of the drug were: the incidence of renal colic, the severity of pain during stone passage, the timing of the release of the urinary tract from fragments after lithotripsy, the dynamics of changes in the general analysis of urine and in the microbiological study of urine (leukocyturia, bacteriuria), the dynamics of changes in the biochemical analysis blood and urine (metabolic disorders), tolerance and safety of the drug.

Was urolithiasis presented by different clinics?
in the form of coral stones: 14 patients underwent percutaneous nephrolithotripsy, renal nephrostomy, 4 patients had kidney stones larger than 2.0 cm, they underwent contact pyelolithotripsy.The remaining 12 patients underwent EBRT (internal stent or nephrostomy). Bacteriuria was detected in 16 patients (titer 10 -10), they received anti-inflammatory antibiotic therapy in accordance with the data of urine culture, antibiotic sensitivity.

After the performed surgical interventions, residual stones ranging in size from 0.3 to 1.0 cm were found in all patients. Large fragments of calculi (more than 0.5 cm) were subsequently subjected to remote lithotripsy.While taking the drug, the discharge of small fragments of stones (up to a maximum of 0.5 cm) both through the nephrostomy and during spontaneous urination was noted in 73% of cases, in the control group only in 32% of cases. The greatest efficiency was noted in the group of patients with stones and “stone paths” of the lower third of the ureter, and amounted to 83% in the first group and 51% in the control group. It should be noted that the frequency of renal colic and their severity were significantly lower in patients taking Rovatinex against the background of antispasmodic therapy.The rate of discharge of stone fragments was 43.1% higher in the study group. Complete release from stones was achieved in 67% of cases in group I, 24% in the control group. 5 patients underwent extracorporeal lithotripsy for residual stones and stone paths of the lower third of the ureter, 6 patients at the time of control examination had clinically insignificant fragments of calculi capable of spontaneous discharge. During the control laboratory examination, it was revealed that the drug Rovatinex does not have a pronounced effect on the result of urine culture.However, in the general analysis of urine, there was a significant (p> 0.05) decrease in leukocyturia and an increase in the amount of salts (urates, phosphates, oxalates). In the biochemical analysis of blood and urine, there were no significant changes in the indicators of stone-forming substances and urine pH, the level of nitrogenous toxins. Against the background of the entire period of taking the drug, patients noted an increase in diuresis (by 43.2%), the absence of side effects of treatment directly related to the use of the drug Rovatinex.

Conclusion

The performed treatment showed the effectiveness of the use of the drug Rovatinex in the complex treatment of patients suffering from urolithiasis and undergoing surgery to remove stones of the kidneys and ureters.The use of the drug is especially indicated for microliths of the kidneys and ureters, during the formation of “stone paths”, tk. helps to reduce the number and severity of renal colic and faster passage of fragments. An additional advantage of the drug is its good tolerance.

Currently, the clinical efficacy of Rovatinex for the treatment of patients with kidney and ureteral stones is beyond doubt. The spectrum of published clinical trials of the drug provides compelling evidence of the benefits of Rovatinex therapy.?

Keywords: urolithiasis, treatment, phytopreparations, Rovatinex.

Keywords : nephrolithiasis, urolithiasis, treatment, herbs, Rowatinex.

Literature

1. Stern P., Vukcevic S. On the alteration of nephrocalcinosis in the rat // Urol. 1960. Vol. 53. P. 59-63.
2. Chromatographic studies of the enantiomeric composition of some therapeutic compositions applied in the treatment of liver and kidney diseases / Sybilska D., Kowalczyk J., Asztemborska M., Ochocka RJ, Lamparczyk H. // J Chromatogr A. 1994. Vol. 665. No. 1. P. 67-73.
3. Engelstein D., Kahan E., Servadio C. Rowatinex for the treatment of ureterolithiasis // J. Urol. 1992. Vol. 98. No. 2. P. 98-100.
4. Mukamel E., Engelstein D., Simon D., Servadio C. The value of Rowatinex in the treatment of ureterolithiasis // J. Urol. 1987. Vol. 93. No. 1. P. 31-33.
5. Romics I., Siller G., Kohnen R., Mavrogenis S., Varga J., Holman E. A special terpene combination (Rowatinex®) improves stone clearance after extracorporeal shockwave lithotripsy in urolithiasis patients: results of a placebo-controlled randomized controlled trial / // Urol Int. 2011. Vol. 86. No. 1. P. 102-109.
6. Djaladat H., Mahouri K., Khalifeh Shooshtary F., Ahmadieh A. Effect of Rowatinex on calculus clearance after extracorporeal shock wave lithotripsy // Urol. J. 2009. Vol. 6. No. 1. P. 9-13.
7. Pricop C., Novac C.gUl Y.E., Kayigil O. Evaluation of the efficiency of tamsulosin and Rowatinex in patients with distal ureteral stones: a prospective, randomized, controlled study // Int Urol Nephrol. 2010. Vol. 42. No. 2. P. 325-330.
8. Javad-Zade S.M. Urolithiasis in the epidemic region: etiopathogenesis, clinical picture, treatment: author. dis. Dr. med. Science. M. 1997.26 p.

9. Healy K.A., Ogan K. Nonsurgical management of urolithiasis: an overview of expulsive therapy // J.Endourol. 2005. Vol. 19.No. 7.P. 759-767.
10. Yamamoto I., Korai Y., Nakamura T. Clinical use of rowatinex in urolithiasis // Nippon Hinyokika Gakkai Zasshi. 1963. Vol. 54. P.753-757.
11. Stern P., Vukcevic S. On the alteration of nephrocalcinosis in the rat // Urol. 1960.
    Vol. 53. P. 59-63.
12. Chromatographic studies of the enantiomeric composition of some therapeutic
    compositions applied in the treatment of liver and kidney diseases / Sybilska D.,
    Kowalczyk J., Asztemborska M., Ochocka RJ, Lamparczyk H. // J Chromatogr A.
    1994. Vol. 665. No. 1. P. 67-73.
13. Engelstein D., Kahan E., Servadio C. Rowatinex for the treatment of ureterolithiasis //
    J. Urol. 1992. Vol. 98. No. 2. P. 98-100.
14. Mukamel E., Engelstein D., Simon D., Servadio C. The value of Rowatinex in the treatment of ureterolithiasis // J. Urol. 1987. Vol. 93. No. 1. P. 31-33.
15. Romics I., Siller G., Kohnen R., Mavrogenis S., Varga J., Holman E. A special terpene
    combination (rowatinex®) improves stone clearance after extracorporeal
    shockwave lithotripsy in urolithiasis patients: results of a placebo-controlled randomized
    controlled trial / // Urol Int. 2011. Vol. 86. No. 1. P. 102-109.
16. Djaladat H., Mahouri K., Khalifeh Shooshtary F., Ahmadieh A. Effect of Rowatinex
    on calculus clearance after extracorporeal shock wave lithotripsy // Urol. J. 2009. Vol. 6. No. 1. P. 9-13.
17. Pricop C., Novac C., Negru D., Ilie C., Pricop A., Tanase V. Can selective alphablockers
    help the spontaneous passage of the stones located in the uretero-bladder
    junction? // Rev Med Chir Soc Med Nat Iasi. 2004. Vol. 108. No. 1. P.128-133.
18. Aldemir M., Uçgül Y.E., Kay? Gil O. Evaluation of the efficiency of tamsulosin and
    Rowatinex in patients with distal ureteral stones: a prospective, randomized, controlled
    study // Int Urol Nephrol. 2010. Vol. 42. No. 2. P. 325-330.
19. Javad-Zade S.M. Urolithiasis in the epidemic region:
    etiopathogenesis, clinical picture, treatment: author. dis. Dr. med. Science. M. 1997.26 p.

Lithotripsy (stone removal): a method of treating urolithiasis

Urolithiasis is a fairly common pathology in urology that occurs in patients of different ages.This disease is manifested by the deposition of calculi in the organs of the urinary system.

About one of the modern methods of stone removal – laser lithotripsy – we talked with Stepan Petrovich Sidorov, a urologist, a surgeon at the Clinic Expert Irkutsk.

– Stepan Petrovich, how often in your practice do you have to deal with urolithiasis?

– This disease is very common. During examination, almost every second can detect urolithiasis.But only one in five complains. We quite often detect the presence of stones of different sizes during screening examination.

– What is kidney stone lithotripsy?

– This is the destruction of stones in the calyx-pelvis system. In our clinic, the removal of kidney stones is performed with a laser.

– What is the advantage of laser lithotripsy?

– The energy of the laser allows you to break stones almost into dust.All other types of lithotripsy (ultrasonic, pneumatic) break the stones into larger fragments, which during the operation can scatter along the calyx-pelvic system. And then, when leaving, they bring additional torment.

– Do I need special preparation for laser lithotripsy?

– Presence of stones implies a chronic urinary infection. Therefore, anti-inflammatory and antibacterial treatment is carried out. And, of course, general somatic training is important.It consists in stabilizing the patient’s health status in diseases such as arterial hypertension, coronary heart disease (IHD), stomach and duodenal ulcers, pancreatitis, cholecystitis, etc.

– How is laser lithotripsy performed?

– Crushing of kidney stones can occur in two scenarios. The first involves removing stones through natural pathways. In this case, through the urethra, we enter the ureter, remove the stone in it, then rise higher and remove the stone in the pelvis.And another situation is when we have a large stone in the pelvis. In this case, by means of ultrasonic guidance through the skin, we pass into the calyx-pelvis system and create, let’s say, an artificial port connecting the external environment with the pelvis. Then, using microscopic equipment, we burn the stone there.

– How long is the session?

– The operation can take 40 minutes or maybe three hours. It depends on the shape, size, density, location of the stone, the physique of the patient, and whether he had surgery before or not.

– What complications can arise after laser lithotripsy?

– If we talk about access through natural routes, then injuries to the urethra, ureter, pelvis, bleeding, exacerbation of chronic urinary infection are possible. If the operation is performed through the skin, then it may be damage to the vessels of the kidney, pyelonephritis, urinary leakage, injury to neighboring organs.

– How long will it take to recover from the procedure?

– It depends on how the operation went, how long it took, the patient’s condition before the intervention.Usually in 3-5 days the person is already able to work.

– Is one laser lithotripsy session enough to get rid of stones?

– Not always in one session we can remove all the stones. This again depends on their location. In some situations, stones are not available in one approach. And sometimes the patient’s condition or the bleeding that has begun forces them to stop manipulating.

In addition, the operation does not guarantee that stones will not form again.After its implementation, the patient needs constant monitoring by a urologist to prevent further stone formation.

– For whom is laser lithotripsy contraindicated?

– There are no absolute contraindications. Only the general somatic state of a person is taken into account. It happens that the operation is planned, but the patient has problems with the cardiovascular system, with the lungs or the gastrointestinal tract, or there is an oncopathology at the last stage. In such cases, the operation is performed after the condition has stabilized.

– Stepan Petrovich, why are stones formed at all? What is the reason?

– There is always some kind of provoking factor that leads to stone formation. These can be problems with the thyroid gland, adrenal glands, digestion, poor diet, physical inactivity, pyelonephritis, trauma, chronic urinary infection. As well as neglect of hygiene rules, drinking a small amount of liquid, ignoring the urge to urinate in the bladder, poor quality of drinking water.

– Give advice to our readers: how to avoid stone formation?

– Compliance with the water regime is in the first place. It is necessary to consume one and a half to two liters of pure liquid. Tea, coffee, soups are not liquid, but, on the contrary, products that draw it out of the body, thereby concentrating urine. In addition, you need to go to urinate more often, to monitor your health, the state of the endocrine system, gastrointestinal tract. And, of course, proper nutrition and exercise are important.

For information:

Sidorov Stepan Petrovich

Graduated from Irkutsk State Medical University in 2009

2009 – 2010 – internship in general surgery

2010 – 2012 – Residency in the specialty “Urology”

At present – head of the urological center, urologist, andrologist, surgeon, ultrasound diagnostics doctor at the Expert Clinic Irkutsk

Extracorporeal lithotripsy – non-surgical treatment of kidney stones

Urolithiasis ranks second in prevalence after inflammatory nonspecific diseases of the kidneys and urinary tract and tends to grow.According to some reports, currently the incidence in the world reaches 3-5%. In 45-50% of patients newly hospitalized for urolithiasis (Urolithiasis), ureteral stones are diagnosed.

Until the end of the 70s of the last century, the main methods of treating kidney and ureteral stones were conservative therapy aimed at minimizing renal dysfunction and calculus discharge, and if it was ineffective, open surgery was performed. The accumulated experience in the treatment of urolithiasis has confirmed the opinion of the majority of urologists that conservative therapy is effective in 85–90% in patients with ureteral stones, the size of which does not exceed 0.5 cm.

The lack of a good effect of conservative therapy for large ureteral stones contributed to the high percentage of open surgical interventions. The recurrence of stone formation in previously operated patients is 10-15%, which significantly complicates the process of subsequent treatment. Cicatricial and sclerotic changes in the perineal tissue worsen the urodynamics of the kidney and ureter and contribute to recurrent stone formation, and, if necessary, reoperation significantly complicates its performance.

At present, with the introduction into clinical practice of minimally invasive and atraumatic methods of treatment, indications for open surgical removal of ureteral stones are limited and are used in patients with complicated forms of urolithiasis.

The widespread introduction into practice of extracorporeal shock wave lithotripsy (ESWL) has significantly changed the approach to the treatment of urolithiasis. As a result of the introduction of DLT, the statistics of operational activity has changed.

The low invasiveness of the SWL method made it possible to successfully treat patients with severe concomitant diseases and to get rid of stones in elderly patients.The terms of hospitalization of patients with urolithiasis were also significantly reduced, and patients with single small stones of the urinary tract may be allowed outpatient SWL or lithotripsy in a day hospital.

Currently, SWL is regarded as the “gold standard” method and is used to treat 75–80% of patients with urinary tract stones. The number of lithotripsy sessions depends on many factors: size, chemical composition, structure, density and localization of the stone, the duration of the stone standing in the ureter, the presence of an inflammatory process, as well as the functional state of the upper urinary tract.

Despite the high efficiency and low invasiveness of extracorporeal lithotripsy, there are contraindications to the use of this method. SWL should not be performed during pregnancy if the patient has blood clotting disorders, active inflammation, aortic aneurysm, urinary tract obstruction; if the stone is too dense or the patient’s physical characteristics prevent the shockwave from reaching the stone.

To prepare for the procedure, you must pass blood and urine tests (as before any operation) and consult an anesthesiologist.It is necessary to inform the attending physician in advance about taking medications.

The SWL procedure itself lasts about 45 minutes. The patient is positioned on the operating table in such a way that the shock-wave applicator is as close as possible to the destroyed stone. The exact location of the stone is determined using ultrasound and X-ray guidance. During the session, patients hear a sound similar to short clicks. The doctor starts with low-intensity pulses, gradually increasing the strength of the impact.

Shockwaves, when properly focused, can shatter stones. Failure occurs due to erosion and cracking. The surrounding tissues are not damaged due to their elasticity, and also because they are out of focus of the shock wave.

The patient returns to his normal lifestyle, as a rule, on the day of SWL, leaving the hospital a few hours after the procedure. In this case, the patient is given clear instructions in which cases he needs to urgently go to the clinic.

The doctor will definitely tell you the time of follow-up follow-up visits after SWL to evaluate the results.

Remote lithotripsy can be performed at City Hospital No. 4 on a paid basis. Prior consultation with a specialist is required.

For questions of passing DLT, please call: 261-05-56, 444-06-00.

Extracorporeal shock wave lithotripsy (ESWL) – Clinic 29

Crushing stones in organs without breaking the skin is called lithotripsy .It is carried out when the stones cannot leave the body on their own. This method has been used in medicine for more than a decade. Its meaning is that a shock wave aimed at a stone destroys it with short impulses, this happens gradually and lasts until only dust remains from the stone. The Germans were the first to use this procedure, they quickly realized that this method was one of the safest. There are two types of it: contact and distance lithotripsy of ureteral kidney stones.As with any intervention in the body, it has both pros and cons.

The method of extracorporeal shock wave lithotripsy (ESWL) was discovered and introduced into practice in the 1980s. This method actually revolutionized the treatment of urolithiasis, as it is non-invasive, low-traumatic and highly effective.

The principle of this method of treatment of urolithiasis is to use shock waves to destroy stones. This allows the stone to be shattered into smaller pieces that can more easily pass through the ureter or dissolve.

Currently, there are various devices for lithotripsy with different sources of shock wave generation (electrohydraulic, electromagnetic and piezoceramic).

The lithotripsy method is characterized by a smaller number of complications in comparison with other surgical and minimally invasive methods of treating urolithiasis. In addition, ESWL is characterized by a shorter recovery period, as well as twice the pain period. Patients after ESWL are discharged faster and return to work.

It should be understood that lithotripsy does not cure urolithiasis, but only destroys the stones he has. That is, the patient in this case is not insured against the fact that he will have stones again. Therefore, after a course of lithotripsy, he needs to constantly take measures to prevent stone formation.

Indications for lithotripsy

Among the main parameters that were previously taken into account as indications for lithotripsy is the size of the stone.In the early 1980s, stones up to 1.5 cm in size were the main indication for lithotripsy.However, modern ESWL devices allow crushing stones from 0.5 to 2.5 cm in size. not so much the size of the stone as its physical and chemical properties. We also note that the lithotripsy method is effective in both adults and children.

Contraindications to lithotripsy

Among the contraindications to lithotripsy are the impossibility of accurately targeting the stone in the shock wave zone (urate stones, deformity of the spine, support-motor apparatus, obesity, etc.).etc.). Among the absolute contraindications to lithotripsy are bleeding disorders, as well as conditions in which the patient takes anticoagulants, as well as menstruation.

Another contraindication to ESWL is the pathology of the gastrointestinal tract during the period of its exacerbation, since the impact of the shock wave in the area of ​​the inflamed intestinal wall can lead not only to aggravation of the disease, but even to intestinal bleeding and hemorrhages in the intestinal wall.

Lithotripsy is also contraindicated for any purulent and inflammatory processes (pneumonia, prostatitis, etc.). Among the urological contraindications for lithotripsy are renal tumor and cavernous renal tuberculosis.

In addition, lithotripsy is contraindicated in violation of cardiac activity (atrial fibrillation, artificial pacemaker, presence of cardiopulmonary failure), decreased kidney function by more than 50%, pregnancy.

Preparation for lithotripsy

Since inflammation is a contraindication to ESWL, a complex of antibiotic therapy, infusion therapy, drugs that improve microcirculation and vitamins are usually performed before this procedure.This allows the kidney to be prepared for shock waves and reduce the likelihood of complications, as well as shorten the rehabilitation period.

Anesthesia for lithotripsy

Many modern lithotripsy devices allow this procedure to be carried out without anesthesia. Despite this, most patients experience moderate pain. As a rule, it is associated with the passage of shock waves through the skin and irritation of the nerve endings.

How is the procedure going

The lithotripsy procedure usually lasts an average of 1 hour, during which the patient can receive up to 8000 shock waves.Usually, the lithotripsy procedure begins with low energy shock waves with long intervals between pulses. This allows the patient to get used to the procedure. Gradually, the strength and frequency of the shock waves gradually increase. If there is bone (such as a rib) in the path of the shock wave near the stone, the procedure becomes more painful because the wave causes some resonance in the bone.

In order to facilitate the removal of stone fragments, a ureteral stent can be used, which widens the lumen of the ureter.

Complications during lithotripsy

Despite the fact that lithotripsy is a non-invasive method of destroying stones, it also has some complications, since this method is associated with a mechanical effect on the kidney tissue.

Complications may be due to the characteristics of the patient himself, or due to the incorrect technique of the lithotripsy procedure, incorrect selection of indications for the procedure. Among the complications of lithotripsy are:

• Kidney hematomas – hemorrhage in the kidney tissue. Their reasons may be that the patient has factors that contribute to its formation (for example, bleeding disorders, taking anticoagulants, menstruation, pyelonephritis).
• Hematuria is the presence of blood in the urine. Hematuria occurs in almost all (100%) patients after ESWL. However, with the correct technique of performing lithotripsy, it goes through 1 – 2 acts of urination.
• Urinary tract obstruction. This is one of the pressing problems of lithotripsy.The fact is that a large stone, when it is in one place, usually does not interfere with the outflow of urine, while its fragments already have greater mobility and there is always a risk of blockage (obstruction) of the ureter.