Presentation Authors: Mohammed Elbaset, Abdelwahab Hashem, Mansoura, Egypt, Ahmed Eraky*, Waren, Germany, Osama Ezzat, Mohamed Sharaf, Ahmed El-Assmy, Khaled Sheir, Ahmed Shokeir, Mansoura, Egypt
Introduction: Non-invasive modalities for radiolucent stone management in adult patients had sparse trials. We aim to evaluateefficacy of ODT, SWL and combined SWL and ODT for medium sized radiolucent renal calculi.
Methods: A randomized controlled trial (RCT) registered at clinicaltrials.gov (NCT03388060) for patients with medium sized renal stone(s) 1-2.5 cm, â‰¤ 500 Hounsfield unit (HU). The ODT patients were counseled for oral potassium citrate. The 2nd group underwent SWL and the last group had combined SWL and ODT. The primary outcome, stone free rate (SFR) at 3 months, was assessed by Non-contrast Computed Tomography (NCCT). We defined complete response (success) if no residual fragment by NCCT. Partial response (failure) if there was a decrease in stone size and not free of residual stones. No response (failure)if there was no change or increase in stone size.
Results: 150 patients completed follow up. Patients&[prime] demographic were comparable in groups. The stone free rate (SFR) at 1st month and 3rd month were; 8 (16%) and 25 (50%) in ODT group, 5(10%) and 23(46%) in SWL group, 17(35%) and 36(72%) patients in combined group with (p= 0.03 and 0.003), respectively. The SFR for all group was 84(66%). In multivariate analysis, combined type of intervention and presence of initial response in first month follow up were the independent factors predicting SFR. Besides, combined ODT and SWL had significantly decreased the overall stone volume (p=0.03) and the need for another stone management procedures after 3 months (p=0.01).
Conclusions: Combined ODT and SWL is the most rapid and effective treatment approach for medium sized radiolucent renal stones and significantly decreases the overall stone volume especially in presence of initial response. It also decreases the SWL sessions in comparison to SWL alone.