Medical management of urolithiasis: Great efforts and limited progress
Victoria Jahrreissa,Christian Seitza*(),Fahad Quhalb
aDepartment of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria bDepartment of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
Objective: To provide a comprehensive review on the existing literature on medical management of urolithiasis.
Methods: A thorough literature review was performed using Medline, PubMed/PMC, Embase, and the Cochrane Database of Systematic Reviews up to December 2022 to identify publications on the medical management of urolithiasis. Studies that assessed dietary and pharmacologic management of urolithiasis were reviewed; studies on medical expulsive therapy were not included in this review.
Results: Medical management of urolithiasis ranges from the prophylactic management of kidney stone disease to dissolution therapies. While most treatment concepts have been long established, large randomized controlled trials are scarce. Dietary modification and increased fluid intake remain cornerstones in the conservative management of urolithiasis. A major limitation for medical management of urolithiasis is poor patient compliance.
Conclusion: Medical management of urolithiasis is more important in patients with recurrent urolithiasis and patients with metabolic abnormalities putting them at higher risk of developing stones. Although medical management can be effective in limiting stone recurrence, medical interventions often fail due to poor compliance.
. [J]. Asian Journal of Urology, 2024, 11(2): 149-155.
Victoria Jahrreiss, Christian Seitz, Fahad Quhal. Medical management of urolithiasis: Great efforts and limited progress. Asian Journal of Urology, 2024, 11(2): 149-155.
? Uric acid stones refractory to hydration and urine alkalization
? Liver-function test abnormalities
Calcium supplements [42]
? Not available
? Enteric hyperoxaluria
? Not available
Tiopronin [48]
? Adults: dose starts at 600-900 mg per day, divided three times a day ? Children of >20 kg: dose starts at 15 mg/kg per day
? Cystine stones refractory to hydration and urine alkalization
? Nausea
? Vomiting
? Diarrhea
? Mouth ulcers
? Rash
? Proteinuria
d-Penicillamine [48]
? 500-1500 mg per day, divided two to three times a day
? Cystine stones refractory to hydration and urine alkalization
? Pancytopenia
? Proteinuria
? Nausea
? Impaired taste
? Rash
Captopril [55]
? 50-150 mg per day
? Cystine stones refractory to hydration and urine alkalization in patients intolerant to cystine-binding agents
? Rash
? Hypotension
Pyridoxine [44]
? 5-10 mg/kg per day
? Primary hyperoxaluria type 1
? Diarrhea
Lumasiran [45]
? Loading dose: 3 mg/kg once monthly for 3 months ? Maintenance dose: 3 mg/kg once every 3 months
? Primary hyperoxaluria type 1
? Injection-site reaction
? Headache
? Rhinitis
? Upper respiratory infection
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