Investigating the Influence of Tutukon and Alfuzosin on Stone Expulsion After Retrograde Intrarenal Surgery
Öz
Objective: To compare the effects of an alpha-blocker (alfuzosin) versus a herbal agent, “Tutukon®,» on stone-free rates in patients who underwent retrograde intrarenal surgery (RIRS).
Material and Methods: We evaluated seventy-five patients who underwent RIRS prospectively consecutively and reported retrospectively between January 2020 and June 2020. Patients were divided into three groups to analyze the effect of medications on stone-free rates after RIRS. “Tutukon®» was prescribed to the first group, alfuzosin 10 mg to the second group, and only dexketoprofen to the third group as the control group. The patients were re-evaluated for stone-free rates after the fourth week of surgery.
Results: Among the groups (Tutukon®/Alfuzosin/Control), no differences were observed in terms of age (44.4±15.71/43.16±14.05/46.00±14.43), stone size, stone location and extracorporeal shock wave lithotripsy (ESWL) history (p>0.05). Complete stone-free rates at the fourth postoperative week; Group 1 (Tutukon®) was 96%, group 2 (alfuzosin) 84%, and group 3 (control) 76% (p=0.163), and the stone-free rate in Group 1 was significantly higher than that in the control group (Group 1 vs. 3; p= 0.044, Group 2 vs. 3; p=0.363). Evaluation of completely stone-free patients and patients with clinically insignificant residual stones showed no difference between the groups (p=0.234).
Conclusion: The data obtained from the use of Tutukon® have similar results to the use of alfuzosin in medical expulsive therapy, suggesting that it may be a preferred phytotherapy method for fragment expulsion after endoscopic stone surgery.
Anahtar Kelimeler
Medical expulsive treatment urolithiasis herbal agent alfa blocker and retrograde intrarenal surgery
Kaynakça
- 1. Benson DA, Maxwell RM, Poeter E, et al. EAU guidelines on urolithiasis. European Association of Urology. 2019;49(1):1-88.
- 2. Soyupek S, Armaǧan A, Koşar A, et al. Risk factors for the formation of a steinstrasse after shock wave lithotripsy. Urologia internationalis. 2005;74(4):323-5. https://doi.org/10.1159/000084431
- 3. Amer T, Osman B, Johnstone A, et al. Medical expulsive therapy for ureteric stones: Analysing the evidence from systematic reviews and meta-analysis of powered double-blinded randomised controlled trials. Arab journal of urology. 2017;15(2):83-93. https://doi.org/10.1016/J.AJU.2017.03.005
- 4. Tao RZ, Qin ZQ, Liu F De, et al. Efficacy and Safety of Tamsulosin in the Medical Expulsion Therapy for Distal Ureteral Calculi: A Systematic Review and Meta-Analysis of Placebo-Controlled Trials. Urology journal. 2019;16(3):224-31. https://doi.org/10.22037/UJ.V0I0.4758
- 5. Somani BK, Aboumarzouk O, Traxer O, et al. Medical expulsive therapy for ureteral stones: where do we go from here? Nature reviews Urology. 2016;13(10):608-12. https://doi.org/10.1038/NRUROL.2016.146
- 6. Celik S, Akdeniz F, Yildirim MA, et al. Tadalafil versus alpha blockers (alfuzosin, doxazosin, tamsulosin and silodosin) as medical expulsive therapy for. Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica. 2018;90(2):117-22. https://doi.org/10.4081/AIUA.2018.2.117
- 7. Koski RR, Zufall WH. Efficacy and Safety of Alpha-Blockers for Kidney Stones in Adults. The Journal of pharmacy technology : jPT : official publication of the Association of Pharmacy Technicians. 2018;34(2):54-61. https://doi.org/10.1177/8755122517750398
- 8. Liu XJ, Wen JG, Wan YD, et al. Role of silodosin as medical expulsive therapy in ureteral calculi: a meta-analysis of randomized controlled trials. Urolithiasis. 2018;46(2):211-8. https://doi.org/10.1007/S00240-017-0974-1
- 9. Khan A, Bashir S, Khan SR. Antiurolithic effects of medicinal plants: results of in vivo studies in rat models of calcium oxalate nephrolithiasis-a systematic review. Urolithiasis. 2021;49(2):95-122. https://doi.org/10.1007/S00240-020-01236-0
- 10. Alyaev YG, Rudenko VI, Perekalina AN, et al. [Plant-derived terpenes in treating patients with urolithiasis]. Urologiia (Moscow, Russia :1999). 2016;(2 Suppl 2):103-10.
- 11. Gürocak S, Küpeli B. Consumption of historical and current phytotherapeutic agents for urolithiasis: a critical review. The Journal of urology. 2006;176(2):450-5. https://doi.org/10.1016/J.JURO.2006.03.034
- 12. Nirumand MC, Hajialyani M, Rahimi R, et al. Dietary plants for the prevention and management of kidney stones: Preclinical and clinical evidence and molecular mechanisms. International Journal of Molecular Sciences. 2018;19(3). https://doi.org/10.3390/ijms19030765
- 13. Atmani F, Slimani Y, Mimouni M, et al. Prophylaxis of calcium oxalate stones by Herniaria hirsuta on experimentally induced nephrolithiasis in rats. BJU international. 2003;92(1):137-40. https://doi.org/10.1046/J.1464-410X.2003.04289.X
- 14. Rassweiler JJ, Renner C, Eisenberger F. The management of complex renal stones. BJU international. 2000;86(8):919-28. https://doi.org/10.1046/J.1464-410X.2000.00906.X
- 15. Shrestha A, Corrales M, Adhikari B, et al. Comparison of low power and high power holmium YAG laser settings in flexible ureteroscopy. World Journal of Urology. 2022;40(7):1839-44. https://doi.org/10.1007/s00345-022-04040-0
- 16. Ventimiglia E, Pauchard F, Quadrini F, et al. High- and Low-Power Laser Lithotripsy Achieves Similar Results: A Systematic Review and Meta-Analysis of Available Clinical Series. Journal of endourology. 2021;35(8):1146-52. https://doi.org/10.1089/END.2020.0090
- 17. Prezioso D, Barone B, Di Domenico D, et al. Stone residual fragments: A thorny problem. Urologia Journal. 2019;86(4):169-76. https://doi.org/10.1177/0391560319860654
- 18. Cheung MC, Leung YL, Wong BBW, et al. Prospective study on ultrasonography plus plain radiography in predicting residual obstruction after extracorporeal shock wave lithotripsy for ureteral stones. Urology. 2002;59(3):340-3. https://doi.org/10.1016/S0090-4295(01)01584-9
- 19. Resorlu B, Kara C, Resorlu EB, et al. Effectiveness of ultrasonography in the postoperative follow-up of pediatric patients undergoing ureteroscopic stone manipulation. Pediatric Surgery International. 2011;27(12):1337-41. https://doi.org/10.1007/s00383-011-2979-0
- 20. Catalano O, Nunziata A, Altei F, et al. Suspected ureteral colic: primary helical CT versus selective helical CT after unenhanced radiography and sonography. AJR American journal of roentgenology. 2002;178(2):379-87. https://doi.org/10.2214/AJR.178.2.1780379
- 21. Öztürk MI, Gürbüz C, Koca O, et al. Current situation of ureteral stone diagnosis and treatment: A cross-sectional survey from Istanbul. Turk Uroloji Dergisi. 2010;36(2):125-31. https://doi.org/10.5152/tud.2010.005
- 22. Sharma G, Pareek T, Kaundal P, et al. Comparison of efficacy of three commonly used alpha-blockers as medical expulsive therapy for distal ureter stones: A systematic review and network meta-analysis. International braz j urol : official journal of the Brazilian Society of Urology. 2022;48(5):742-59. https://doi.org/10.1590/S1677-5538.IBJU.2020.0548
- 23. Alsaikhan B, Koziarz A, Lee JY, et al. Preoperative Alpha-Blockers for Ureteroscopy for Ureteral Stones: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of endourology. 2020;34(1):33-41. https://doi.org/10.1089/END.2019.0520
- 24. Dawson CH, Tomson CRV. Kidney stone disease: pathophysiology, investigation and medical treatment. Clinical medicine (London, England). 2012;12(5):467-71. https://doi.org/10.7861/CLINMEDICINE.12-5-467
- 25. Kasote DM, Jagtap SD, Thapa D, et al. Herbal remedies for urinary stones used in India and China: A review. Journal of ethnopharmacology. 2017;203:55-68. https://doi.org/10.1016/J.JEP.2017.03.038
- 26. Aggarwal A, Singla SK, Tandon C. Urolithiasis: phytotherapy as an adjunct therapy. Indian journal of experimental biology. 2014;52(2):103-11.
- 27. Garbens A, Pearle MS. Causes and prevention of kidney stones: separating myth from fact. BJU international. 2021;128(6):661-6. https://doi.org/10.1111/BJU.15532
- 28. Yuruk E, Tuken M, Sahin C, et al. The protective effects of an herbal agent tutukon on ethylene glycol and zinc disk induced urolithiasis model in a rat model. Urolithiasis. 2016;44(6):501-7. https://doi.org/10.1007/S00240-016-0889-2
- 29. Sahin C, Sarikaya S, Basak K, et al. Limitation of apoptotic changes and crystal deposition by Tutukon following hyperoxaluria-induced tubular cell injury in rat model. Urolithiasis. 2015;43(4):313-22. https://doi.org/10.1007/S00240-015-0777-1
- 30. Noureddine B, Mostafa E, Mandal SC. Ethnobotanical, pharmacological, phytochemical, and clinical investigations on Moroccan medicinal plants traditionally used for the management of renal dysfunctions. Journal of Ethnopharmacology. 2022;292:115178. https://doi.org/10.1016/J.JEP.2022.115178
Tutukon ve Alfuzosin’in Retrograd İntrarenal Cerrahi Sonrası Taş Ekspulsiyonu Etkisinin Araştırılması
Öz
Amaç: Retrograd intrarenal cerrahi (RIRC) uygulanan hastalarda bir alfa-bloker (alfuzosin) ile bitkisel bir ajan olan “Tutukon®»un taşsızlık oranları üzerindeki etkilerini karşılaştırmak.
Gereç ve Yöntemler: Ocak 2020 ve Haziran 2020 tarihleri arasında RIRC uygulanan yetmiş beş hasta prospektif olarak değerlendirildi ve retrospektif olarak raporlandı. RIRC sonrası ilaçların taşsızlık oranları üzerindeki etkisini analiz etmek için hastalar üç gruba ayrıldı. Birinci gruba “Tutukon®», ikinci gruba alfuzosin 10 mg ve üçüncü gruba kontrol grubu olarak sadece deksketoprofen reçete edilmiştir. Hastalar ameliyatın dördüncü haftasından sonra taşsızlık oranları açısından tekrar değerlendirildi.
Bulgular: Gruplar (Tutukon®/Alfuzosin/Kontrol) arasında yaş (44.4 ±3.14/43.16 ±2.81/46.00±2.88), taş boyutu, taşın yeri ve ekstrakorporeal şok dalga litotripsi (ESWL) öyküsü açısından fark gözlenmedi (p>0.05). Ameliyat sonrası dördüncü haftada tam taşsızlık oranları; Grup 1 (Tutukon®) %96, grup 2 (alfuzosin) %84 ve grup 3 (kontrol) %76 (p=0.163) olup, Grup 1’deki taşsızlık oranı kontrol grubuna göre anlamlı derecede yüksekti (Grup 1 vs. 3; p= 0.044, Grup 2 vs. 3; p=0.363). Tamamen taşsız hastalar ve klinik olarak önemsiz rezidüel taşları olan hastalar değerlendirildiğinde gruplar arasında fark saptanmadı (p=0.234).
Sonuç: Tutukon® kullanımından elde edilen veriler, alfuzosinin tıbbi eksülsif tedavide kullanımına benzer sonuçlara sahip olup, endoskopik taş cerrahisi sonrası fragman atılmasında tercih edilebilecek bir fitoterapi yöntemi olabileceğini düşündürmektedir.
Anahtar Kelimeler
medikal ekspulsif tedavi ürolitiyazis bitkisel ajan alfa bloker retrograd intrarenal cerrahi
Kaynakça
- 1. Benson DA, Maxwell RM, Poeter E, et al. EAU guidelines on urolithiasis. European Association of Urology. 2019;49(1):1-88.
- 2. Soyupek S, Armaǧan A, Koşar A, et al. Risk factors for the formation of a steinstrasse after shock wave lithotripsy. Urologia internationalis. 2005;74(4):323-5. https://doi.org/10.1159/000084431
- 3. Amer T, Osman B, Johnstone A, et al. Medical expulsive therapy for ureteric stones: Analysing the evidence from systematic reviews and meta-analysis of powered double-blinded randomised controlled trials. Arab journal of urology. 2017;15(2):83-93. https://doi.org/10.1016/J.AJU.2017.03.005
- 4. Tao RZ, Qin ZQ, Liu F De, et al. Efficacy and Safety of Tamsulosin in the Medical Expulsion Therapy for Distal Ureteral Calculi: A Systematic Review and Meta-Analysis of Placebo-Controlled Trials. Urology journal. 2019;16(3):224-31. https://doi.org/10.22037/UJ.V0I0.4758
- 5. Somani BK, Aboumarzouk O, Traxer O, et al. Medical expulsive therapy for ureteral stones: where do we go from here? Nature reviews Urology. 2016;13(10):608-12. https://doi.org/10.1038/NRUROL.2016.146
- 6. Celik S, Akdeniz F, Yildirim MA, et al. Tadalafil versus alpha blockers (alfuzosin, doxazosin, tamsulosin and silodosin) as medical expulsive therapy for. Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica. 2018;90(2):117-22. https://doi.org/10.4081/AIUA.2018.2.117
- 7. Koski RR, Zufall WH. Efficacy and Safety of Alpha-Blockers for Kidney Stones in Adults. The Journal of pharmacy technology : jPT : official publication of the Association of Pharmacy Technicians. 2018;34(2):54-61. https://doi.org/10.1177/8755122517750398
- 8. Liu XJ, Wen JG, Wan YD, et al. Role of silodosin as medical expulsive therapy in ureteral calculi: a meta-analysis of randomized controlled trials. Urolithiasis. 2018;46(2):211-8. https://doi.org/10.1007/S00240-017-0974-1
- 9. Khan A, Bashir S, Khan SR. Antiurolithic effects of medicinal plants: results of in vivo studies in rat models of calcium oxalate nephrolithiasis-a systematic review. Urolithiasis. 2021;49(2):95-122. https://doi.org/10.1007/S00240-020-01236-0
- 10. Alyaev YG, Rudenko VI, Perekalina AN, et al. [Plant-derived terpenes in treating patients with urolithiasis]. Urologiia (Moscow, Russia :1999). 2016;(2 Suppl 2):103-10.
- 11. Gürocak S, Küpeli B. Consumption of historical and current phytotherapeutic agents for urolithiasis: a critical review. The Journal of urology. 2006;176(2):450-5. https://doi.org/10.1016/J.JURO.2006.03.034
- 12. Nirumand MC, Hajialyani M, Rahimi R, et al. Dietary plants for the prevention and management of kidney stones: Preclinical and clinical evidence and molecular mechanisms. International Journal of Molecular Sciences. 2018;19(3). https://doi.org/10.3390/ijms19030765
- 13. Atmani F, Slimani Y, Mimouni M, et al. Prophylaxis of calcium oxalate stones by Herniaria hirsuta on experimentally induced nephrolithiasis in rats. BJU international. 2003;92(1):137-40. https://doi.org/10.1046/J.1464-410X.2003.04289.X
- 14. Rassweiler JJ, Renner C, Eisenberger F. The management of complex renal stones. BJU international. 2000;86(8):919-28. https://doi.org/10.1046/J.1464-410X.2000.00906.X
- 15. Shrestha A, Corrales M, Adhikari B, et al. Comparison of low power and high power holmium YAG laser settings in flexible ureteroscopy. World Journal of Urology. 2022;40(7):1839-44. https://doi.org/10.1007/s00345-022-04040-0
- 16. Ventimiglia E, Pauchard F, Quadrini F, et al. High- and Low-Power Laser Lithotripsy Achieves Similar Results: A Systematic Review and Meta-Analysis of Available Clinical Series. Journal of endourology. 2021;35(8):1146-52. https://doi.org/10.1089/END.2020.0090
- 17. Prezioso D, Barone B, Di Domenico D, et al. Stone residual fragments: A thorny problem. Urologia Journal. 2019;86(4):169-76. https://doi.org/10.1177/0391560319860654
- 18. Cheung MC, Leung YL, Wong BBW, et al. Prospective study on ultrasonography plus plain radiography in predicting residual obstruction after extracorporeal shock wave lithotripsy for ureteral stones. Urology. 2002;59(3):340-3. https://doi.org/10.1016/S0090-4295(01)01584-9
- 19. Resorlu B, Kara C, Resorlu EB, et al. Effectiveness of ultrasonography in the postoperative follow-up of pediatric patients undergoing ureteroscopic stone manipulation. Pediatric Surgery International. 2011;27(12):1337-41. https://doi.org/10.1007/s00383-011-2979-0
- 20. Catalano O, Nunziata A, Altei F, et al. Suspected ureteral colic: primary helical CT versus selective helical CT after unenhanced radiography and sonography. AJR American journal of roentgenology. 2002;178(2):379-87. https://doi.org/10.2214/AJR.178.2.1780379
- 21. Öztürk MI, Gürbüz C, Koca O, et al. Current situation of ureteral stone diagnosis and treatment: A cross-sectional survey from Istanbul. Turk Uroloji Dergisi. 2010;36(2):125-31. https://doi.org/10.5152/tud.2010.005
- 22. Sharma G, Pareek T, Kaundal P, et al. Comparison of efficacy of three commonly used alpha-blockers as medical expulsive therapy for distal ureter stones: A systematic review and network meta-analysis. International braz j urol : official journal of the Brazilian Society of Urology. 2022;48(5):742-59. https://doi.org/10.1590/S1677-5538.IBJU.2020.0548
- 23. Alsaikhan B, Koziarz A, Lee JY, et al. Preoperative Alpha-Blockers for Ureteroscopy for Ureteral Stones: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of endourology. 2020;34(1):33-41. https://doi.org/10.1089/END.2019.0520
- 24. Dawson CH, Tomson CRV. Kidney stone disease: pathophysiology, investigation and medical treatment. Clinical medicine (London, England). 2012;12(5):467-71. https://doi.org/10.7861/CLINMEDICINE.12-5-467
- 25. Kasote DM, Jagtap SD, Thapa D, et al. Herbal remedies for urinary stones used in India and China: A review. Journal of ethnopharmacology. 2017;203:55-68. https://doi.org/10.1016/J.JEP.2017.03.038
- 26. Aggarwal A, Singla SK, Tandon C. Urolithiasis: phytotherapy as an adjunct therapy. Indian journal of experimental biology. 2014;52(2):103-11.
- 27. Garbens A, Pearle MS. Causes and prevention of kidney stones: separating myth from fact. BJU international. 2021;128(6):661-6. https://doi.org/10.1111/BJU.15532
- 28. Yuruk E, Tuken M, Sahin C, et al. The protective effects of an herbal agent tutukon on ethylene glycol and zinc disk induced urolithiasis model in a rat model. Urolithiasis. 2016;44(6):501-7. https://doi.org/10.1007/S00240-016-0889-2
- 29. Sahin C, Sarikaya S, Basak K, et al. Limitation of apoptotic changes and crystal deposition by Tutukon following hyperoxaluria-induced tubular cell injury in rat model. Urolithiasis. 2015;43(4):313-22. https://doi.org/10.1007/S00240-015-0777-1
- 30. Noureddine B, Mostafa E, Mandal SC. Ethnobotanical, pharmacological, phytochemical, and clinical investigations on Moroccan medicinal plants traditionally used for the management of renal dysfunctions. Journal of Ethnopharmacology. 2022;292:115178. https://doi.org/10.1016/J.JEP.2022.115178
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Üroloji |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Ocak 2024 |
| Gönderilme Tarihi | 15 Kasım 2023 |
| Kabul Tarihi | 25 Ocak 2024 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 16 Sayı: 1 |
