Effects of Intravenous Fluid and Diuretics on Stone Fragmentation and Passage during Extracorporeal Shock Wave Lithotripsy (ESWL) of Upper Ureteral Stone

Shin, Ji Hyun; Moon, Young Tae

Abstract

PURPOSE: A prospective randomized controlled trial was performed to investigate the effects of intravenous hydration, both with and without diuretics, on the fragmentation and passage of an upper ureteral stone during ESWL.
MATERIALS AND METHODS
We analyzed 65 patients with upper ureteral stones, primarily treated with piezoelectric LT-02 lithotripter, between November, 2001 and March, 2002. The patients were divided in 3 groups; the 20 patients in group A were injected with 500ml of normal saline for intravenous hydration, and 20mg of furosemide for diuretic effect during the ESWL; the 20 patients in group B were injected with normal saline without furosemide, and the remaining 25, group C, were used as controls. The same energy settings for the shockwaves in one session were equally applied to all the patients during the ESWL, with a 4Hz shockwave frequency, 100% power, a 50 minute treatment and 43 minute storage time. After 2 weeks, the degrees of stone fragmentation, and the residual fragments, were evaluated on the post-ESWL KUB and compared with the pre-ESWL KUB.
RESULTS
After a single ESWL treatment, the stone-free rate was 70% (14 of 20 patients) in group A, 60% (12 of 20 patients) in group B and 28% (7 of 25 patients) in group C (p<0.05). The stone-free rates of groups A and B were significantly higher than that of group C, but there was no statistical difference between groups A and B. The stone-free rates, after a single session, according to the stone size was higher in groups A (77.8%) and B (73.3%) than in group C (38.9%) for stones smaller than 10mm (p<0.05), but they were similar between the three groups for stones larger than 10mm (p>0.05).
CONCLUSIONS
Intravenous hydration with normal saline, both with and without a furosemide injection for diuretic effect, during ESWL would be an effective method to facilitate the fragmentation and passage of upper ureteral stones smaller than 10mm.