Thermochemotherapy in adjuvant treatment of primary high risk non muscle invasive bladder cancers: Single center results.

OBJECTIVE: To evaluate the results of Thermochemotherapy in adjuvant treatment of primary high risk non-muscle invasive bladder cancer in our center. METHODS: The study included 26 patients with an age of 51-78 years (mean: 62.4 years). All patients had transurethral tumor resection (TURB) after being diagnosed with a primary bladder tumor and were pathologically diagnosed with non-muscle invasive urothelial carcinoma. Thermochemotherapy (TCT) applications were performed via the Synergo® system SB-TS 101. RESULTS: Of the study participants, 13 patients had T1 Grade III, six patients had T1Grade III CIS (+), four patients had Ta Grade III, and three patients Ta Grade II multiple > 5 cm tumor. In all patients, six weeks plus six months protocol were completed. All patients completed the follow-up protocol. With a median follow-up time of 16.4 months (range: 6 - 48 months), recurrent urothelial carcinoma was identified in three patients. With a median follow-up time of 16.4 months, the recurrence-free survival was 88.4% in 26 patients included in the study. CONCLUSIONS: The obtained data suggest that the TCT method can be used effectively and safely in non-muscle invasive bladder cancers of primary high-risk. Prospective randomized studies will shed light on this subject which are BCG vs TCT in primary high risk patients and second course BCG vs TCT in the BCG insufficient patients.

Combination of Tramadol and Lidocaine for Pain Control During Transrectal Ultrasound-guided Prostate Biopsy: A Randomized Double-blinded Study.

OBJECTIVE: To evaluate the efficacy of tramadol, lidocaine, and a combination of tramadol with lidocaine in pain relief using periprostatic nerve block technique by guidance of transrectal ultrasound (TRUS) before the prostate biopsy (PBx). MATERIALS AND METHODS: For the indication of TRUS-PBx, the patients with a prostate-specific antigen (PSA) level >4.0 ng/mL or abnormal digital examination findings were selected. The patients were randomized through random method. Group 1: patients were administered 5 mL of 2% lidocaine; group 2: patients were administered 5 mL of 25-mg tramadol; and group 3: patients were administered 5 mL of 2% lidocaine + 25-mg tramadol. The procedures were completed in 10 minutes, and a visual pain scale was administered to the patients to question the pain severity. RESULTS: TRUS-guided PBx was performed in 60 patients with an age range of 57-77 years (mean age, 66.2 ± 7.49 years) and a PSA range of 1-1000 ng/mL. The mean PSA level of the groups was 28.5 (±7.5), 16.1 (±5.0), and 14.9 (±2.9) ng/mL, respectively. The postprocedural pain scores by visual pain scale were 4.6 ± 1.2, 5.4 ± 1.2, and 3.6 ± 0.9 in lidocaine, tramadol, and lidocaine + tramadol groups, respectively. CONCLUSION: Periprostatic nerve block is the current golden standard method owing to pain management and comfort provided, independent of the patient age and the number of core biopsies. We suggest that tramadol may also be used in this field to achieve better pain management by improving lidocaine's effect or as an alternative to lidocaine.

Comparison of the complications and the cost of open and laparoscopic radical nephrectomy in renal tumors larger than 7 centimeters.

PURPOSE: To compare the complications and the cost analysis of open radical nephrectomy (ORN) versus laparoscopic radical nephrectomy (LRN) in patients with renal tumors larger than 7 centimeters (cm). MATERIALS AND METHODS: A retrospective analysis was performed in 173 patients (ORN group, n = 140; LRN group, n = 33) who underwent surgery for kidney tumors between 2008 and 2011. Patients' age, tumor size, pre-operative surgical risk score (American Society of Anesthesiologists score), duration of hospitalization, complications and the costs of hospitalization were recorded. The complications in ORN group and LRN group were specified with Modified Clavien System in five grades. RESULTS: The mean age was found 58.52 ± 13.74 years in ORN group, and 58.15 ± 12.81 years in LRN group (P = .847). Post-operative pain necessitating analgesics was observed in all patients (100%) after early post-operative period in both groups (Grade 1 complications). Blood transfusions were required in 51 patients (36.42%) in the ORN group, and 7 (21.21%) patients in the LRN group (Grade 2 complications) (P = .185). Grade 3 complication was not observed in each groups. Grade 4 complications were occurred in 6 (4.28%) patients [aortic injury, acute tubular necrosis, the need for dialysis, respiratory arrest (2), atrial fibrillation] in the ORN group, and in 1 (3.03%) patient (pulmonary embolism) in the LRN group. Grade 5 complication was occurred in 1 (0.71%) patient (death) in the ORN group. By the cost analysis, the average cost of ORN group was €1328, whereas €1508 in LRN group (P < .05). CONCLUSION: Laparoscopy is used in many clinics with an increasing frequency because of the improved patient comfort, better cosmetic results, less post-operative pain, lower transfusion rates, and early return to the daily activities. Besides these advantages, the negligible difference in the costs compared to the open surgery (mean difference = €180 per case) makes it even more attractive.

Comparison of demographic data in patients undergoing Percutaneous Nephrolithotomy in Southeastern Anatolia and the Black Sea region: A multicenter study.

OBJECTIVE: The aim of this study was to compare demographic data in adult patients undergoing percutaneous nephrolithotomy (PNL) for kidney stone disease in university hospitals from Southeastern Anatolia and the Black Sea regions. MATERIAL AND METHODS: The demographic data of 535 (53.3%) patients undergoing PNL from Gaziantep University, Department of Urology (GAUN group), and 468 (46.6%) patients undergoing PNL from Ondokuz Mayis University, Department of Urology (OMU group) were evaluated retrospectively. Patients' gender, mean age, stone laterality, and size and results of the stone analyses were compared. RESULTS: The mean patient ages were 40.94±13.33 (17-81) and 48.03±13.95 (17-81) years in the GAUN and OMU Groups, respectively, (p=0.0001). The mean stone size was 716.01±449.60 (100-3000) mm(2) and 612.7±445.87 (65-3220) mm(2) in the GAUN and OMU Groups, respectively (p= 0.0001). There were no statistically significant differences between the groups with respect to stone laterality (p=0.196), and gender of the patients (p=0.65). Stone analysis revealed that the distribution of stone composition was as follows in the GAUN group: Ca oxalate (90.19%), cystine (7.84%), uric acid (5.88%), and struvite (1.96%). In the OMU group, the stone composition was as follows: Ca oxalate (86.84%), cystine (1.34%), uric acid (13.15%), and struvite (9.21%). CONCLUSION: The incidence of kidney stone disease varies throughout Turkey based on etiological factors, and a higher incidence of kidney stone disease is observed in the Southeastern Anatolia region endemically. Lower mean ages and higher stone sizes in patients undergoing PNL in southeastern Anatolia suggest that geographic factors can affect stone disease.

Primary amyloidosis of the bladder mimicking bladder tumor.

Amyloidosis is a benign, non-neoplastic disease characterized by the deposition of extracellular fibrillar protein in tissues or organs, which may be systemic or localized. Primary amyloidosis localized in the bladder is very rare in the literature and may mimic bladder cancer at presentation. A 31-year-old female patient consulted to our clinic and was diagnosed with primary bladder amyloidosis; intravesical dimethyl sulfoxide (DMSO) therapy was started. To the best of our knowledge, this patient represents the fourth case in the Turkish medical literature.

Comparative outcomes of plasmakinetic versus monopolar transurethral resection of benign prostatic hyperplasia: 7 years' results.

OBJECTIVE: We compared results from the standard monopolar or the bipolar plasmakinetic method for the transurethral resection of the prostate (TURP) due to benign prostatic hyperplasia (BPH) at 4 and 7 years after surgery (medium to long term). MATERIAL AND METHODS: A retrospective analysis was performed on the complete data from 124 patients who were alive and had 7 years of regular follow-up. Of those 124 patients with BPH, 65 (52%) underwent monopolar TURP (M-TURP) and 59 (48%) underwent plasmakinetic TURP (P-TURP). During the follow-up period, the International Prostate Symptom Score (IPSS), the maximal flow rate (Qmax) measured using uroflowmetry and the prostate specific antigen (PSA) values were recorded. Patients in whom alpha blockers were administered due to the growth of postoperative adenoma and who had been operated on due to urethral stricture, bladder neck contracture or a growing adenoma were also noted and recorded. RESULTS: There was no statistically significant difference between M-TURP and P-TURP groups in any pre-operative or post-operative follow-up parameter at 4 or 7 years post-surgery. Specifically, PSA, IPSS and Qmax values; urethrotomies performed; alpha-blocker use; and the frequency of re-operations were statistically insignificant (p>0.05). CONCLUSION: Our study demonstrated that when medium-to long-term results are compared, P-TURP and M-TURP appear to result in similar IPSS scores, Qmax values, complication rates and retreatment rates. Larger prospective studies are required to corroborate these results.

Transvaginal repair of unrecognized bladder injury after transobturator tape surgery.

Currently, minimally invasive surgeries, which are often characterized by reliable and successful results, are preferred for the treatment of stress urinary incontinence. Although all of the currently used surgeries are minimally invasive, morbidities, including hemorrhage, voiding dysfunction, infection, pain, skin infection and erosion, and bladder injuries, are observed. We detected bladder injury in a 42-year-old female patient with complaints of burning and pain during urination who had previously undergone transobturator tape (TOT) surgery. Complete abdominal hysterectomy for a secondary myoma and a TOT procedure had been simultaneously performed 3 months prior to her presentation. Cystoscopy demonstrated a foreign body compatible with sling material in the bladder which was extracted transvaginally.

Comparative analyses of percutaneous nephrolithotomy versus open surgery in pediatric urinary stone disease.

PURPOSE: The aim of this study is to compare the efficiency and reliability of percutaneous nephrolithotomy (PCNL) and open surgery for pediatric urinary stone disease. METHODS: The retrospective analysis included 116 patients (69 PCNL, 47 open stone surgery). The stone surface area, stone-free rates, hospitalization time, blood transfusion rates, and the D-J implantation rates of patients in each group in whom PCNL and open surgery were performed were analyzed. RESULTS: The average age of the patients in the PCNL group was 10.01 ± 0.51 years, and in the open surgery group 8.55 ± 0.68 years. No statistically significant difference was observed between the two groups in average age, stone surface area or stone-free rates. However, hospitalization time (PCNL 2.31 ± 0.46 days, open surgery 3.36 ± 0.64 days), blood transfusion rate (PCNL 10.1 %, open surgery 42.5 %) and D-J catheter implantation rate (PNL 7.24 %, open surgery 42.5 %) of patients who underwent PCNL were determined to be statistically low. CONCLUSION: In light of the results, it is concluded that PCNL supersedes open surgery in terms of the use of advanced instruments and technological developments for modern pediatric surgery.

Effects of intravesical dexpanthenol use on lipid peroxidation and bladder histology in a chemical cystitis animal model.

OBJECTIVE: To demonstrate the effects of intravesical dexpanthenol use on bladder histology and lipid peroxidation in a chemical cystitis animal model. METHODS: Thirty-five New Zealand rabbits were divided into 3 groups. Cystitis was conducted with transurethral intravesical hydrochloric acid instillation on the subjects in groups I and II. Then, Group I subjects were transurethrally administered intravesical dexpanthenol therapy twice a week, Group II subjects were given only intravesical isotonic NaCl instillation, and Group III subjects were administered intravesical isotonic NaCl instillation without conducting chemical cystitis to create the same stress. Treatment schemes of all groups were arranged in the same manner. After 6-week therapy, the rabbits were sacrificed and histopathologic investigations were carried out to demonstrate changes in the urinary bladder. Serum and tissue malondialdehyde (MDA) values were examined to investigate the effect of dexpanthenol on lipid peroxidation. RESULTS: We observed that the basal membrane and mucosal integrity were maintained, inflammatory cells were suppressed, and MDA levels decreased in group I, which received dexpanthenol therapy. However, it was also observed that mucosal integrity was spoiled, numerous inflammatory cells were accumulated, and MDA levels were significantly increased in group II, which was administered isotonic NaCl. CONCLUSION: In light of our findings, intravesical dexpanthenol therapy could be a new therapeutic approach in the treatment of interstitial cystitis because of its low cost and acceptable side effects.

A prospective, randomized controlled study comparing lidocaine and tramadol in periprostatic nerve blockage for transrectal ultrasound-guided prostate biopsy.

OBJECTIVES: To assess the efficacy of tramadol and lidocaine in reducing pain using the periprostatic nerve block technique with a spinal needle, guided by transrectal ultrasound (TRUS) before the biopsy application. METHODS: Of the 112 eligible candidates who were asked to participate in the study, 90 agreed and provided informed consent. These 90 men were randomized into 3 groups. Group 1 (n = 30) received lidocaine, group 2 (n = 29) received tramadol, and group 3 (n = 31) received saline solution. Within 10 minutes of biopsy procedure completion, the patients were presented with visual pain scales and asked to rate the pain. The patients also asked whether they would be to return for this procedure if it became medically necessary. RESULTS: The postprocedural mean pain scores of lidocaine, tramadol, and placebo groups were found to be 1.73, 2.89, and 4.32, respectively. The mean pain scores were significantly lower in both the lidocaine and the tramadol groups compared with the placebo group (P <.001). In addition, statistically significant differences were found among the 3 groups regarding how willing they would be to return for the procedure if necessary. CONCLUSIONS: In this study, we showed that the local anesthetic effect of tramadol in decreasing pain in periprostatic nerve block during TRUS-guided biopsy. The use of tramadol for pain relief in transrectal ultrasound-guided prostate biopsy is a practical, effective, and comfortable method compared with the results of the control group.

Evaluation of relationship between HIF-1alpha immunoreactivity and stage, grade, angiogenic profile and proliferative index in bladder urothelial carcinomas.

Hypoxia-inducible factor-1alpha (HIF-1alpha) is a critical regulatory protein of cellular response to hypoxia. In this study, we evaluated the relationship of HIF-1alpha with clinicopathologic parameters such as tumor stage and grade, as well as angiogenic profile and proliferation index. The immunoreactivity of HIF-1alpha was assessed in 70 cases of primary bladder urothelial carcinoma. Vascular endothelial growth factor (VEGF) and microvessel density (MVD) were used to evaluate the angiogenic profile. MVD was calculated by immunohistochemical staining of endothelial cells with CD34. Proliferation index was determined by the percentage of Ki-67 nuclear staining in tumor cells. There was a significant relationship between HIF-1alpha immunoreactivity and stage, as well as histologic grade of the tumor (P < 0.001). HIF-1alpha immunoreactivity was also closely related to VEGF expression (P < 0.001), MVD (P = 0.002) and proliferation index (P < 0.001). VEGF, MVD and proliferation index were found to be closely related to tumor stage and histologic grade. There was no correlation between HIF-1alpha immunoreactivity and lamina propria (P = 0.13), muscularis propria (P = 0.009) or vascular invasion (P = 0.1). In this study, HIF-1alpha expression was found to be closely related to prognostic parameters in bladder urothelial carcinoma. For this reason, it may be a useful marker to determine the prognosis and to choose the appropriate treatment modality.

Primary synovial sarcoma of the kidney: use of PET/CT in diagnosis and follow-up.

Primary renal synovial sarcoma is a rarely seen renal neoplasm. An experienced uropathologist is needed to make the pathological diagnosis. A patient, operated on with a prediagnosis of renal cell carcinoma, the pathology of which was reported as synovial sarcoma, is presented in this article. 18F-fluoro-deoxyglucose positron emission tomography and computed tomography were performed preoperatively and in the postoperative follow-up to detect the primary tumor and lymph node metastases.

The use of artificial neural networks in decision support in vesicoureteral reflux treatment.

AIM: To develop a prediction model based on artificial neural networks (ANN) for the treatment selection in vesicoureteral reflux (VUR). METHODS: A total of 96 children with VUR (145 ureteric units (UU)) were treated at our institution during 2004-2006. An ANN based on quick propagation architecture was created with the commercially available software package. The patients' age and sex, the cause and grade of VUR, the affected ureter, the type of treatment (conservative, subureteric injection, or open surgery), existence of renal scar on DMSA, follow-up times and the number of injections were used as variables. These data were also transferred to a statistical software package and regression analysis was done. RESULTS: In all, 105 UU showed no reflux, 5 UU showed improvements in reflux grade (considered only in the conservative management group), and the remaining 35 UU showed persistence. In the training group (n = 99), ANN showed 98.5% sensitivity, 92.5% specificity, 97% positive predictive value, and 96% negative predictive value in predicting treatment outcome. CONCLUSIONS: We have demonstrated that ANN can accurately predict the resolution of VUR, and thus could be useful in daily clinical practice. This approach would allow urologists to aid in the decision-making process of VUR treatment.

Evaluation of urinary oxalate levels in patients receiving gastrointestinal lipase inhibitor.

OBJECTIVE: The purpose of this study was to examine the possible effects of a gastrointestinal lipase inhibitor "Orlistat (Xenical)" on the intestinal absorption of oxalate and thereby on the urinary levels of oxalate excretion in overweight patients. METHODS AND PROCEDURES: Long-term follow-up data of 95 cases (57 men, 38 women; M/W=1.5) were documented. Patients were randomly assigned into two groups. While the patients in group I (n=55) were treated with orlistat (Xenical) for 6 months, patients in group II (n=40) received no specific medication. Calcium, oxalate, and citrate levels were determined in a 24-h urine collection from each patient. To evaluate the significance in the groups as well as the differences between the two groups, ANOVA test was performed and the results were given as mean +/- s.d. RESULTS: Comparative evaluation of urinary oxalate levels during 3-month follow-up clearly showed that urinary oxalate excretion significantly increased in 34/55 patients (61.8%) in the first group (P<0.05). Of these 34 patients, 30 (88.2%) continued to have increased urinary oxalate excretion during 6-month follow-up (P=0.001). However, our data did not show any significant effect of this medication on urinary citrate and calcium levels during 3- and 6-month follow-up evaluation (P=0.05). DISCUSSION: Our results suggest that increased intestinal absorption of dietary oxalate due to this type of medication in obese patients could make a substantial contribution to urinary oxalate excretion and may increase the risk of stone formation.

Verapamil prevents the apoptotic and hemodynamic changes in response to unilateral ureteral obstruction.

INTRODUCTION: Obstruction of the urinary tract has marked effects on renal blood flow, glomerular filtration rate (GFR), and tubular function. Moreover, ureteral obstruction results in an injury response that can progress to irreversible renal fibrosis and tubular atrophy by apoptosis. METHODS: We examined the effect of a calcium channel blocker (verapamil) on renal functions and the abundance of apoptotic (p53, Fas, proliferating cell nuclear antigen [PCNA]) markers 1 week after Unilateral Ureteral Obstruction (UUO). RESULTS: Immunohistochemistry studies revealed that UUO was markedly associated with up-regulation in the expression of p53 (1550 +/- 82 vs 100 +/- 23%), Fas (657 +/- 48 vs 100 +/- 31%), and proliferating cell nuclear antigen (945 +/- 70 vs 100 +/- 17% of sham levels). Administration of verapamil normalized the up-regulation of apoptotic markers p53 (724 +/- 116 vs 1550 +/- 82%); Fas (162 +/- 38 vs 657 +/- 48%) and PCNA (353 +/- 54 vs 945 +/- 70%). Furthermore, tubular diameter, as an important marker for detecting tubular atrophy was significantly decreased compared to those in UUO rabbits. The percent area of interstitial fibrosis in UUO kidneys was significantly greater than that in Verapamil-treated kidneys. Importantly, Verapamil reduced the development of interstitial fibrosis in UUO rabbits. We measured the GFR and renal blood flow in UUO. Short-term Verapamil challenge partially prevented the decrease in GFR (non-treated UUO: 62 +/- 14; Verapamil + UUO: 119 +/- 7; Sham: 127 +/- 23 microL x min(-1) x kg body wt(-1), P < 0.05) and renal blood flow (non-treated UUO: 1.1 +/- 0.4; Verapamil + UUO: 5.0 +/- 0.2; sham: 6.3 +/- 0.2 mL x min(-1) x kg body wt(-1), P < 0.05). CONCLUSION: Verapamil significantly prevents impairment in renal function and also prevents the up-regulation of p53, Fas, and PCNA during UUO, demonstrating a marked renoprotective effect of Verapamil treatment in conditions with urinary tract obstruction.

Verapamil attenuates renal tubular apoptosis in response to partial unilateral ureteral obstruction.

INTRODUCTION: Partial unilateral ureteral obstruction (PUUO) is the type of obstruction that is most often encountered in pediatric clinical practice. The majority of our knowledge on PUUO has been derived from experimental studies and the effects of PUUO on the kidney have still been a source of continual investigation. MATERIAL AND METHODS: In the present study, renal expression of p53, Fas and PCNA were examined in rabbits with long-term (4 weeks) partial obstruction. Additionally, the effect of calcium channel blocker on pronounced apoptotic changes were evaluated. RESULTS: Immunohistochemistry results revealed that PUUO for 4 weeks caused an upregulation of p53 to 55.2 +/- 2% and Fas to 30.1 +/- 1.1%, whereas verapamil challenge attenuated the expression of these two apoptotic markers (p53: 15.9 +/- 1.8%; Fas: 18.2 +/- 1.4%, p < 0.05). Importantly, PCNA activity was also increased in response to PUUO. However, verapamil treatment after onset of obstruction caused a markedly decrease in the expression of PCNA (42.9 +/- 10.8% vs. 9.6 +/- 2.1%, PUUO, PUUO + verapamil; respectively, p < 0.05). CONCLUSION: The expression of p53, Fas and PCNA molecules is associated with long-term partial ureteral obstruction, whereas verapamil seems to be a protective agent against apoptotic changes.

Comparative evaluation of efficacy of use of tamsulosin and/or tolterodine for medical treatment of distal ureteral stones.

OBJECTIVES: To evaluate the activity of the therapeutic agents (tamsulosin and/or tolterodine) used to accelerate the expulsion of stones and to reduce the probable complications during observation of the medical treatment of distal ureteral stones to allow spontaneous passage. METHODS: A total of 120 patients with distal ureteral stones were included in the study. Patients with stones less than 10 mm and allowing urinary flow were included in the study. The patients were studied in four randomly divided groups. Group 1 patients received tamsulosin 0.4 mg/day, group 2 patients received tamsulosin 0.4 mg/day plus tolterodine 2 mg (twice a day), group 3 patients received tolterodine 2 mg (twice a day), and group 4 patients did not receive any medical treatment (control group). RESULTS: Differences among the four groups in patient age and stone dimension were not statistically significant (P >0.05). The stone expulsion rates were greater (P <0.05) in groups 1 and 2 than in groups 3 and 4. A significant variation (P <0.05) regarding the time to stone expulsion was observed in groups 1 and 2. CONCLUSIONS: In our study, the use of tamsulosin for the expulsion of distal ureteral stones was effective; however, the use of tolterodine provided no additional advantages.

Effect of potassium citrate therapy on stone recurrence and regrowth after extracorporeal shockwave lithotripsy in children.

BACKGROUND AND PURPOSE: Stone disease in children may cause functional and morphologic changes in the urinary tract during longer-term follow-up. Prevention of stone recurrence will be possible only with careful metabolic evaluation and appropriate management. The possible preventive effects of potassium citrate therapy on true stone recurrence, as well as regrowth rates after shockwave lithotripsy (SWL), were evaluated in children treated for renal stones. PATIENTS AND METHODS: Following assessment of the efficacy of SWL, 96 children (72 male, 53 female aged 4 to 14 years with a mean of 6.6 years) were evaluated for the effects of potassium citrate on residual fragments as well as true new stone formation during long-term follow-up. All children had calcium-containing stones with normal renal morphology and function without any urinary-tract infection. Depending on the outcome of treatment, patients with and without residual stones were allocated independently to Group I (N = 52) and Group II (N = 44), which were matched for sex and age. Group I was given oral potassium citrate 1 mEq/kg daily for 12 months; the remaining children served as controls. Follow-up ranged from 12 to 36.6 months, with a mean of 24.4 months. Follow-up results for at least a year with respect to the stone recurrence or stone growth rates were recorded in both groups. RESULTS: Stone-free children undergoing no specific therapy had significant new stone formation compared with the group receiving potassium citrate on a regular basis (34.6% and 7.6%, respectively). Children with residual fragments receiving no specific preventive measure also showed significant new stone formation, along with enlargement of the fragments. CONCLUSION: In addition to stone removal, treatment of pediatric urolithiasis requires a thorough metabolic evaluation. Depending on the abnormalities, each patient should be advised on adequate drinking to increase the urine volume in accordance with body size. Although children with hypocitraturia may well benefit from therapeutic agents that raise the urine citrate concentration, our results did clearly show that all children bearing residual fragments should be counseled on adequate fluid intake along potassium citrate treatment to prevent stone regrowth or formation during long-term follow-up.

The effect of calcium channel blockers on stone regrowth and recurrence after shock wave lithotripsy.

We evaluated the possible effects of a calcium entry blocking agent "verapamil" on new stone formation and/or regrowth of residual fragments after shock wave lithotripsy (SWL) during long-term follow-up (>30 months) and compared the results with the success rates of adequate fluid intake. A total of 70 patients treated with SWL were randomly divided into three different groups, in the first two of which the patients received different preventive measures with respect to stone recurrence and/or regrowth. While 25 patients received a calcium channel blocking agent, verapamil hydrochloride, beginning 3 days before SWL and continued 4 weeks after the procedure, an additional 25 patients were put in an enforced fluid intake program and the remaining 20 patients received no specific medication and/or measure apart from close follow-up. Patients were followed regularly with respect to the clearance/regrowth of the residual fragments and that of new stone formation during long-term follow-up (within a mean follow-up of 30.4 months). The overall stone recurrence rate was 14% (10/70). Of the patients who became stone free (12/25, 48%) in group I, only one patient (1/12, 8.3%) showed a new stone formation during long-term follow-up. The figure was 40% (4/10) in group II patients and 55% (5/9) in group III patients receiving no specific medication. Regarding the residual stone fragments (<5 mm) after SWL, again high fluid intake was found to be the most effective on stone regrowth rates (2/13, 15.3%). Patients treated with verapamil also had acceptable regrowth rates (3/15, 20%). Finally, verapamil treatment significantly improved the clearance of residual fragments; while 7 out of 15 patients with residual fragments passed these particles successfully, (46.5%) in this group; these figures were 46% (6/13) and 18% (2/13) in the remaining groups. Residual fragments located in lower calyces demonstrated a poor clearance rate with higher regrowth rates. Verapamil administration was found to be effective enough to limit the regrowth of residual fragments and also to facilitate residual fragment clearance after SWL. Patients receiving this medication seemed to pass the retained fragments easily in a shorter time than the others.