Combined Oral Dissolution Therapy and Shock Wave Lithotripsy Effective in Treatment of Medium-Sized Radiolucent Renal Stones

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The efficacy of combined oral dissolution therapy (ODT) and shock wave lithotripsy (SWL) was superior to ODT or SWL alone in the treatment of medium-sized radiolucent renal stone (RLS), concluded a recent trial. The combined therapeutic approach reduced the overall stone volume as well as the frequency of SWL sessions needed in comparison to SWL therapy, alone.

This study evaluated the efficacy of ODT, SWL and combined SWL and ODT in 150 patients with medium-sized RLS, 1–2.5 cm, ≤ 500 Hounsfield unit (HU). The patients were randomized to receive either oral potassium sodium-hydrogen citrate or undergo SWL or received combined ODT and SWL.

Non-contrast computed tomography (NCCT) assessed the stone-free rate (SFR) at 3 months. Complete response or success was considered in absence of detection of residual fragment. A decrease in stone size, but presence of residual stones was defined as partial response or failure. No change or increase in stone size was considered as no response.

The overall SFR was 66%. The combined ODT+SWL group had a significantly higher SFR as compared to the other 2 groups. The SFR at 1st month and 3rd month were, respectively; 16% and 50% in the ODT group, 10% and 46% in the SWL group, and 35% and 72% patients in combined group with (p = 0.03 and 0.003, respectively).

Combined treatment and initial response in first month follow-up independently predicted SFR. The overall stone volume and the number of SWL sessions after 3 months were significantly reduced in the combined treatment group (p=0.03 and p=0.01) respectively.

World J Urol 2019. DOI: 10.1007/s00345-019-02746-2.