Kidney Stones
Conditions
Keywords
Kidney stones, renal calculi, nephrolithiasis, flexible ureteroscopy, ureteroscopy, laser lithotripsy, residual stone fragments, stone-free rate, forced diuresis, furosemide, non-contrast computed tomography
Brief summary
This randomized controlled clinical trial evaluated whether furosemide-assisted forced diuresis during flexible ureteroscopy reduced the residual fragment rate and improved stone clearance in patients with renal stones measuring up to 30 millimeters. Adult patients undergoing flexible ureteroscopy were randomized into two parallel groups: an experimental group that received intravenous furosemide during the procedure and a control group that received standard perioperative and postoperative care without furosemide. Residual stone fragments were assessed using low-dose non-contrast computed tomography on postoperative day 1 and at 6 weeks after the procedure. The primary outcome was the proportion of patients with residual stone fragments greater than 2 millimeters on postoperative day 1. Secondary outcomes included the proportion of patients with residual stone fragments greater than 2 millimeters at 6 weeks, operative time, postoperative complications, and the need for auxiliary treatment for clinically significant residual stones.
Interventions
DRUGFurosemide
Intravenous furosemide was administered as a total dose of 40 milligrams during the procedure, divided into 20 milligrams given 5 minutes after induction of anesthesia and 20 milligrams given 30 minutes after the start of the procedure.
OTHERStandard Care After Flexible Ureteroscopy Without Furosemide
Participants received standard perioperative and postoperative management after flexible ureteroscopy without administration of furosemide or any other diuretic medication.
Sponsors
Ain Shams University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Participants were randomly assigned in a one-to-one ratio to receive either intravenous furosemide-assisted forced diuresis during flexible ureteroscopy or standard care without furosemide during flexible ureteroscopy.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients aged 18 years or older. * Patients who underwent flexible ureteroscopy for renal stones measuring 30 millimeters or less.
Exclusion criteria
* Patients with active urinary tract infection. * Patients with a history of previous open renal surgery or renal trauma. * Patients with contraindications to anesthesia, such as severe cardiac disease, uncontrolled diabetes mellitus, or severe coagulation disorder. * Patients with severe renal impairment, defined as an estimated glomerular filtration rate less than 30 milliliters per minute per 1.73 square meters. * Known Ureteric stricture and pelvi-ureteric junction obstruction * Patients with a single kidney. * Patients with contraindications to furosemide administration. * Patients with congenital renal anomalies.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of patients with residual stone fragments greater than 2 mm | Postoperative day 1 after flexible ureteroscopy | Residual stone fragments were assessed using low-dose non-contrast computed tomography (CT) performed on postoperative day 1. The outcome was reported as the proportion of patients with one or more residual renal stone fragments measuring greater than 2 mm. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Operative time | During procedure | Operative time was calculated from insertion of the ureteroscope into the urethra until completion of ureteral stent placement. |
| Postoperative urinary tract infection | Within 7 days post-procedure | Postoperative urinary tract infection was assessed within seven days after the procedure using fever with urinary symptoms and or a positive urine culture with significant bacteriuria. |
| Need for auxiliary treatment for clinically significant residual stones | Up to 6 weeks after flexible ureteroscopy | The need for auxiliary treatment for clinically significant residual stones was recorded, including extracorporeal shock wave lithotripsy or repeat ureteroscopy. |
| Proportion of patients with residual stone fragments greater than 2 mm at 6 weeks | 6 weeks after flexible ureteroscopy | Residual stone fragments were assessed using low-dose non-contrast computed tomography (CT) performed 6 weeks after flexible ureteroscopy. The outcome was reported as the proportion of patients with one or more residual renal stone fragments measuring greater than 2 mm. |
Countries
Egypt
Outcome results
None listed