Effective treatment of kidney stones: A Synthesis of Findings from 20 Studies

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Original Abstract of the Article

Major Research Findings

Various methods are used to treat kidney stones. 18 , 11 , and 8 show that percutaneous nephrolithotomy (PCNL) is effective in treating large and complex stones. 17 states that drug therapy may be effective depending on the type of stone. 16 examines a treatment method that adjusts the position of lower pole stones. 2 compares extracorporeal shock wave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS) for the treatment of lower pole stones. 14 examines the treatment of asymptomatic small stones in kidney transplant donors. 10 examines the duration of antibiotic administration after PCNL for infection stones. 7 examines the effectiveness of hydrochlorothiazide in preventing the recurrence of calcium nephrolithiasis. 6 compares the effectiveness of ultra-mini PCNL, SWL, and flexible ureteroscopy (FURS) for the treatment of 1-2 cm lower pole kidney stones. 19 compares the efficacy and safety of mini-percutaneous nephrolithotomy (MPCNL) in the supine and prone positions in a pediatric population. 5 performs a network meta-analysis of the effectiveness of various surgical methods in treating renal calculi. 9 examines the association of UTIs in patients with KSD and assesses the outcomes of kidney stone treatment in the resolution of rUTI. 15 compares PCNL and RIRS for the treatment of renal stones in adults. 1 examines the cost-effectiveness of ESWL and PCNL for medium-sized kidney stones. 13 re-evaluates the best evidence on this topic in an update of a Cochrane Review first published in 2014. 20 compares the efficacy and safety of mPNL and RIRS for the treatment of 10-20 mm kidney stones in patients with ileal conduit. 12 discusses the metabolic changes in kidney stone disease. 3 examines the effectiveness of citrate salts for preventing and treating calcium-containing kidney stones. 4 compares the one-shot procedure and the sequential metal dilation procedure in PCNL.

Treatment Summary

Kidney stone treatment involves surgical procedures such as ESWL, PCNL, and RIRS, as well as drug therapy and lifestyle modifications. 18 compares performing PCNL simultaneously on both sides with performing it in stages, suggesting that simultaneous bilateral surgery may shorten surgery time, anesthesia time, post-operative pain, and hospital stay. 17 states that drug therapy may be effective depending on the type of stone. 7 examines the effectiveness of hydrochlorothiazide in preventing the recurrence of calcium nephrolithiasis. 12 discusses the metabolic changes in kidney stone disease. 3 examines the effectiveness of citrate salts for preventing and treating calcium-containing kidney stones.

Benefits and Risks

Benefit Summary

Kidney stone treatment methods vary depending on the type, size, and location of the stones. 18 , 8 , and 19 show that PCNL is effective in treating large and complex stones. 18 suggests that performing PCNL simultaneously on both sides may shorten surgery time, anesthesia time, post-operative pain, and hospital stay. 17 shows that drug therapy has the advantages of being less expensive, less invasive, and more readily available than surgery. 7 suggests that hydrochlorothiazide may be effective in preventing the recurrence of calcium nephrolithiasis. 12 shows that understanding metabolic changes may lead to the development of new therapies. 3 suggests that citrate salts may be effective in preventing and treating calcium-containing kidney stones. These findings show that there are various options for kidney stone treatment and that it is essential to choose the appropriate treatment method based on the patient's condition.

Risk Summary

Various risks are associated with kidney stone treatment. 18 reports bleeding, infection, and urinary obstruction as complications of PCNL. 17 reports gastrointestinal symptoms and electrolyte abnormalities as side effects of drug therapy. 12 shows that metabolic changes are deeply involved in the development of kidney stones. 3 reports gastrointestinal symptoms and exacerbation of kidney stones as side effects of citrate salts. These findings show that it is essential to fully understand the risks and benefits of kidney stone treatment and to choose the appropriate treatment method in consultation with a physician.

Comparison Between Studies

Common Points of the Studies

Multiple studies show that surgical methods such as ESWL, PCNL, and RIRS and drug therapy are used to treat kidney stones. 18 , 11 , 8 , 19 , and 13 show that PCNL is effective in treating large and complex stones. 17 , 7 , and 3 suggest that drug therapy may be effective in preventing and treating stones.

Differences Between the Studies

The type, size, and location of stones, the treatment method, and the evaluation criteria vary depending on the study. 18 compares performing PCNL simultaneously on both sides with performing it in stages, but other studies do not make such a comparison. 16 examines a treatment method that adjusts the position of lower pole stones, but other studies do not make such an examination. 14 examines the treatment of asymptomatic small stones in kidney transplant donors, but other studies do not make such an examination. 10 examines the duration of antibiotic administration after PCNL for infection stones, but other studies do not make such an examination. 6 compares the effectiveness of ultra-mini PCNL, SWL, and flexible ureteroscopy (FURS) for the treatment of 1-2 cm lower pole kidney stones, but other studies do not make such a comparison. 5 performs a network meta-analysis of the effectiveness of various surgical methods in treating renal calculi, but other studies do not perform such an analysis. 9 examines the association of UTIs in patients with KSD and assesses the outcomes of kidney stone treatment in the resolution of rUTI, but other studies do not make such an examination. 15 compares PCNL and RIRS for the treatment of renal stones in adults, but other studies do not make such a comparison. 1 examines the cost-effectiveness of ESWL and PCNL for medium-sized kidney stones, but other studies do not make such an examination. 20 compares the efficacy and safety of mPNL and RIRS for the treatment of 10-20 mm kidney stones in patients with ileal conduit, but other studies do not make such a comparison. 4 compares the one-shot procedure and the sequential metal dilation procedure in PCNL, but other studies do not make such a comparison.

Consistency and Contradictions in the Results

Multiple studies show that PCNL is effective in treating large and complex stones. However, 18 suggests that performing PCNL simultaneously on both sides may shorten surgery time, anesthesia time, post-operative pain, and hospital stay, but other studies do not make such a comparison. Also, 17 , 7 , and 3 suggest that drug therapy may be effective in preventing and treating stones, but these studies all target calcium-containing kidney stones, and further research is needed on the effects of drug therapy on other types of stones. Also, 12 shows that metabolic changes are deeply involved in the development of kidney stones, but this study is only a consideration and has not led to the development of specific therapies. These findings show that there are various options for kidney stone treatment and that it is essential to choose the appropriate treatment method based on the patient's condition.

Precautions for Application in Real Life

The following points should be noted when choosing a kidney stone treatment method: * Type, size, and location of stones * Age, gender, and co-morbidities of the patient * Risks and benefits of the treatment method * Patient's wishes It is essential to discuss these points with a physician and choose the appropriate treatment method.

Limitations of Current Research

Current research has the following limitations: * Many studies are small, and it is necessary to be cautious about generalizing the results. * Comparing results can be difficult because the studies have different designs and evaluation criteria. * Many studies target specific types of kidney stones, and further research is needed on therapies for other types of stones. To overcome these limitations, larger studies and studies with standardized designs are needed.

Future Directions for Needed Research

Future research on kidney stone treatment should focus on the following areas: * Development of new therapies * Further evaluation of the effectiveness and safety of existing therapies * Research to improve patient quality of life * Research on kidney stone prevention Through this research, we can expect to improve kidney stone treatments and improve patient quality of life.

Conclusion

Kidney stones are a condition that affects many people worldwide. 18 , 17 , 7 , 12 , and 3 are some of the studies that have been conducted, but there is still room for improvement in the development and improvement of therapies. Kidney stone treatment methods vary depending on the type, size, and location of the stones, as well as the patient's age, gender, and co-morbidities. 18 , 11 , 8 , 19 , and 13 show that PCNL is effective in treating large and complex stones. 17 , 7 , and 3 suggest that drug therapy may be effective in preventing and treating stones. Various risks are associated with kidney stone treatment. 18 , 17 , 12 , and 3 mention the risks of surgery and drug therapy. When choosing a kidney stone treatment method, it is crucial to consult with a physician and choose a therapy that is suitable for your condition.

Treatment List

ESWL, PCNL, RIRS, Drug therapy, Urine pH adjustment, Hydrochlorothiazide, Citrate salts, Lifestyle modifications

Literature analysis of 20 papers
Positive Content
20
Neutral Content
0
Negative Content
0
Article Type
8
4
6
6
19
1.

Cost effectiveness of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy for medium-sized kidney stones. A randomised clinical trial.

Author: CarlssonP, KinnA C, TiseliusH G, OhlsénH, RahmqvistM

Kidney stone treatment
Complications

A study of 55 patients with kidney stones compared percutaneous nephrolithotomy (PNL) and extracorporeal shock wave lithotripsy (ESWL) for treatment. PNL involved longer hospital stays and treatment durations compared to ESWL. ESWL was associated with slightly more pain during treatment and minor complications or pain in the first 10 days after discharge. While PNL had a higher success rate at one year (94% vs. 77%), ESWL was more cost-effective. The study concluded that ESWL is a more efficient and cost-effective option for treating medium-sized kidney stones (6-30 mm), even when considering factors beyond cost, such as complications and patient experience.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

2.

Comparison between retrograde intrarenal surgery and extracorporeal shock wave lithotripsy in the treatment of lower pole kidney stones up to 15 mm. Prospective, randomized study.

Author: VilchesR M, AliagaA, ReyesD, SepulvedaF, MercadoA, MoyaF, LedezmaR, HidalgoJ P, OlmedoT, MarchantF

Improved stone free rate
Longer operative time

Retrograde intrarenal surgery (RIRS) showed similar Stone Free Rate (SFR) to Extracorporeal Shock Wave Lithotripsy (ESWL) in the treatment of lower pole stones, but RIRS was superior regarding absence of clinically significant residual fragments.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

3.

Citrate salts for preventing and treating calcium containing kidney stones in adults.

Author: PhillipsRebecca, HanchanaleVishwanath S, MyattAndy, SomaniBhaskar, NabiGhulam, BiyaniC Shekhar

Kidney stone prevention

Oral citrate therapy is often used to prevent kidney stones, especially in people with low urinary citrate levels, but its effectiveness is uncertain. More research is needed to support its clinical use.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

4.

[Approach to percutaneous nephrolithotomy. Comparison of the procedure in a one-shot versus the sequential with metal dilata].

Author: Sedano-PortilloIsmael, Ochoa-LeónGastón, Fuentes-OrozcoClotilde, Irusteta-JiménezLeire, Michel-EspinozaLuis Rodrigo, Salazar-ParraMarcela, Cuesta-MárquezLizbeth, González-OjedaAlejandro

Kidney Stone Treatment

This controlled clinical trial compared the differences in time of exposure to X-rays and hemoglobin levels between one-shot percutaneous nephrolithotomy and sequential dilatation techniques. One-shot technique demonstrated better results compared to sequential dilatation, with a lower postoperative hemoglobin decline, shorter X-ray exposure time, and lower postoperative creatinine serum levels.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : Spanish

5.

Efficacies of Various Surgical Regimens in the Treatment of Renal Calculi Patients: a Network Meta-Analysis in 25 Enrolled Controlled Clinical Trials.

Author: WangYan-Bo, CuiYan-Xin, SongJun-Nian, YangQian, WangGang

Higher stone-free rate
Shorter hospital stay
Not applicable

Ureterorenoscopy plus retrograde intrarenal surgery (URS + RIRS) had the best stone-free rate and the lowest number of auxiliary procedures for the treatment of renal calculi. RIRS and micropercutaneous nephrolithotomy both had the shortest hospital stay and operative time.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

6.

Comparison of the Efficacy of Ultra-Mini PCNL, Flexible Ureteroscopy, and Shock Wave Lithotripsy on the Treatment of 1-2 cm Lower Pole Renal Calculi.

Author: ZhangHe, HongTian Yu, LiGang, JiangNing, HuChuanyi, CuiXingang, ChuChuanmin, ZhaoJun Long

Kidney stone treatment
GI complications

UMP, FURS, and SWL are all safe and effective in the treatment of 1-2 cm lower pole kidney stones, with UMP and FURS having better stone-free rates than SWL.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

7.

Efficacy of standard and low dose hydrochlorothiazide in the recurrence prevention of calcium nephrolithiasis (NOSTONE trial): protocol for a randomized double-blind placebo-controlled trial.

Author: DhayatNasser A, FallerNicolas, BonnyOlivier, MohebbiNilufar, RitterAlexander, PellegriniLisa, BedinoGiulia, SchönholzerCarlo, VenzinReto M, HüslerCarina, KonethIrene, Del GiornoRosaria, GabuttiLuca, AmicoPatrizia, MayrMichael, OdermattUrs, BuchkremerFlorian, ErnandezThomas, Stoermann-ChopardCatherine, TetaDaniel, RintelenFelix, RoumetMarie, IrincheevaIrina, TrelleSven, TamòLuca, RothBeat, VogtBruno, FusterDaniel G

Medical prophylaxis
Nephrolithiasis treatment

Kidney stones are a common problem, with a high risk of developing them over a lifetime. While treatment for kidney stones is costly and can cause problems, preventing them with medication is a desirable option. Thiazide diuretics have been used for decades to prevent kidney stones, but there is still uncertainty about their benefits and potential harms. Additionally, it is unclear if the low doses of thiazide used currently are effective in preventing kidney stones from returning.

Clinical Trial, Phase IIIA Phase III trial is a trial that further rigorously verifies the efficacy and safety of a new drug or treatment, whose efficacy and safety have been confirmed in a Phase II trial, in a large number of patients, and evaluates whether it is superior to existing treatments.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

8.

A study on comparative outcomes of totally ultrasonography-guided percutaneous nephrolithotomy in prone versus flank position: a randomized clinical trial.

Author: RadfarMoahmmad Hadi, NasiriMahmoudreza, ShemshakiHamidreza, SarhangnejadReza, DadpourMehdi

PCNL for kidney stones

A study was designed to evaluate the outcomes of flank versus prone position in patients who underwent ultrasonic-guided percutaneous nephrolithotomy (PCNL) for treatment of large kidney stones.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

9.

Association of Kidney Stones and Recurrent UTIs: the Chicken and Egg Situation. A Systematic Review of Literature.

Author: RipaFrancesco, PietropaoloAmelia, MontanariEmanuele, HameedB M Zeeshan, GauharVineet, SomaniBhaskar K

UTI resolution with stone removal
Recurrent UTI
Stone formation

Kidney stone disease (KSD) and recurrent urinary tract infections (rUTI) are strongly associated and may be mutually causal. Surgical clearance of kidney stones often resolves rUTIs, but recurrence rates remain uncertain. Proactive stone removal is recommended, especially in cases of recurrent UTIs or additional risk factors.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

10.

Prospective randomized trial of 2 versus 12-weeks of postoperative antibiotics after percutaneous nephrolithotomy in complex patients with infection-related kidney stones.

Author: ChewBen H, ReicherzAlina, KrambeckAmy E, MillerNicole L, HsiRyan S, ScotlandKymora B, MillerDavid, PatersonRyan F, WongVictor K F, SeminsMichelle J, LangeDirk

Treatment for struvite kidney stones
Unknown optimal antibiotic duration

Treating struvite kidney stones, a type of kidney stone caused by infection, involves surgery to remove the stones and antibiotics to treat the infection. While preventive measures are needed to prevent the stones from returning, the best length of time to take antibiotics after surgery is unclear. This study aimed to find out if using antibiotics for 2 weeks or 12 weeks after percutaneous nephrolithotomy (PNL), a procedure to remove kidney stones, resulted in better outcomes in terms of stone recurrence and urine infections.

Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

11.

Comparison of hemodynamic and respiratory outcomes between two surgical positions for percutaneous nephrolithotomy: a prospective, randomized clinical trial.

Author: Dalkilinc HokenekU, ArslanG, OzcanT, Sayin KartJ, Dogu GeyikF, EryildirimB, Tolga SaracogluK

Shorter operation time

This study compared the efficacy and safety of percutaneous nephrolithotomy in the flank versus prone position. The study found that the flank position was associated with better respiratory parameters, less blood loss, and a shorter operation time. The study concluded that the flank position is a viable option for percutaneous nephrolithotomy, but the choice of position should be tailored to individual patient factors and surgeon experience.

Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

12.

Metabolic changes in kidney stone disease.

Author: XuZhenzhen, YaoXiangyang, DuanChen, LiuHaoran, XuHua

Improved understanding of KSD

This manuscript summarizes the progress of research on metabolic changes in kidney stone disease and discusses the potential role of new therapeutic targets. It reviews the influence of metabolism of common substances like oxalate, reactive oxygen species (ROS), macrophage polarization, hormones, and other substances on stone formation.

Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

13.

Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones.

Author: SetthawongVasun, SrisubatAttasit, PotisatSomkiat, LojanapiwatBannakij, PattanittumPorjai

Stone-free rates
Complications

Kidney stones are a common problem. This study updates a previous review to examine the best treatments for kidney stones, comparing shock wave lithotripsy (ESWL) to more invasive procedures like retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL). While RIRS and PCNL are newer techniques, they've become safer with improved methods and tools.

Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

14.

Treatment of donors' asymptomatic small kidney stones and post-transplant outcomes: a meta-analysis.

Author: YinSaifu, ZhouZhaoxia, ZhangFan, WuJiapei, LinTao, WangXianding

Acceptable short-term outcomes
Delayed graft function
Relapse

This meta-analysis summarizes transplant outcomes using kidneys from donors with asymptomatic small kidney stones. The analysis found acceptable short-term outcomes, but long-term data is needed.

Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

15.

Percutaneous nephrolithotomy versus retrograde intrarenal surgery for treatment of renal stones in adults.

Author: SoderbergLeah, ErgunOnuralp, DingMaylynn, ParkerRobin, BorofskyMichael S, PaisVernon, DahmPhilipp

Kidney stone treatment

Kidney stones can cause pain, blockage, and infection. Treatment depends on factors like size, location, and composition of the stone, and may include watchful waiting, shock wave therapy, minimally invasive procedures, or a combination of treatments.

Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

16.

Does displacement of lower pole stones during retrograde intrarenal surgery improves stone-free status? A systematic review and meta-analysis.

Author: SantanaRoberto Nogueira, PortoBreno Cordeiro, PasserottiCarlo Camargo, ArtifonEverson Luiz de Almeida, OtochJosé Pinhata, CruzJosé Arnaldo Shiomi da

Lower pole stone treatment
Stone-free rate
Surgical duration

Displacing lower pole kidney stones for subsequent lithotripsy resulted in a significant improvement in stone-free rates, but increased surgical duration. The benefits of improved clearance rates outweigh the increased surgical time.

Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

17.

Pharmacologic treatment of kidney stones: Current medication and pH monitoring.

Author: SegallM, MousaviA, EisnerB H, ScotlandK

Kidney stone treatment

This scoping review summarizes the available literature on pharmacological strategies for managing different types of kidney stones, including calcium oxalate, calcium phosphate, uric acid, struvite, and cystine stones. The review emphasizes the importance of patient-tailored medical management for nephrolithiasis, considering factors like urine pH, stone crystallization, and metabolic factors.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

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