Date Published: October 2, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Ayyoub Barzegarnezhad, Abolfazl Firouzian, Seyed Abdollah Emadi, Nadali Mousanejad, Roksana Bakhshali.
Introduction. Urinary stone is a common cause of urinary tract disease. Stone excretion using ureteroscope is effective in inferior ureter. The aim of this study was to investigate the effects of aminophylline on ureteral spasm during ureteroscopy in acute phase of renal colic. Methods. In this double-blind randomized clinical trial, 120 patients with ureteral stones were enrolled and randomized into two groups. The bladder was drained and then received a 150 mL irrigation solution. Irrigation solution was saline and saline plus 10 mL aminophylline at 250 mg dose for control and case groups, respectively. Ureteroscopy and transureteral lithotripsy (TUL) were performed five minutes after irrigation. Results. The mean duration of TUL was 4.2 ± 2.61 min and 8.4 ± 2.9 min for control and case groups, respectively. The successful rate was 95% and 76.1% in case and control groups, respectively. Further extracorporeal shock wave lithotripsy (SWL) was performed in 5% and 30% for patients in case and control groups, respectively. Conclusion. Aminophylline facilitated ureteroscopy and increased the success rate in the treatment of renal colic using TUL. No significant complications from post-TUL were observed. Using aminophylline carries several advantages such as reducing procedure duration, decreasing the need for ureteral and double-J catheter, and reducing stone migration to the kidney and use of SWL.
Urinary stone (urolithiasis) is the third common cause of urinary tract disease after urinary infection and renal pathologic features . Ureteral stone mostly results in a pain, which begins in the back and radiates to groin, testis in men and major labia in women . The prevalence of renal lithiasis was reported 10–15% in the United States . Urinary stones lead to urinary retention which is the main reason of renal colic. Renal colic is caused by retraction of urinary collective system or ureter. Symptoms of renal colic depends upon stone location. The ureteroscopy is a widely used urologic procedure and applies in various conditions for diagnosis and treatment of urinary diseases like kidney stones . Stone removal using ureteroscope is effective in inferior parts of a ureter . Two types of washing liquid used during urologic intervention are conductor and nonconductor washing agents. Conductor solutions like saline and ringer lactate are not appropriate in endoelectric surgery. Water and glycine are nonconductor agents . For pain management of renal colic, diclofenac, as well as many other nonsteroidal anti-inflammatory drugs, and antispasmodics such as hyoscine butylbromide and morphine can be used . (Since guide wire and ureteroscope are caused complications during entrance to an acute renal colic ureteral spasm, which can be used agents for relive of spasm and increasing of success of ureteroscopy.) These medications are lidocaine gel, aminophylline, and intravenous Buscopan .
This double-blinded randomized clinical trial was registered by the Iranian Registry of Clinical Trials under code IRCT201106146803N1. After obtaining approval from the Ethical Committee at Mazandaran University of Medical Sciences, this clinical trial was carried out at the emergency department of Imam Khomeini Hospital and Tooba’s Clinical Center in Mazandaran University of Medical Sciences, Sari, Iran. 120 patients with acute renal colic were enrolled for this study; using a computerized software they were randomly assigned into two groups with an equal number of 60 (group A: case and group B: control). All patients gave informed written consent to participate in this study. Patients with history of renal colic, stone excretion, history of transureteral lithotripsy (TUL), anatomic or functional renal disorders and using NSAIDs, corticosteroids, and opioids were excluded. Patients with renal stones <20 mm in distal one 3rd part of ureter and with ages 15–40 years of old were entered in this study. TUL was performed on all study subjects. The mean age of patients in case group (group A) and control group (group B) was 34.8 ± 13.2 years (range: 18–39 years) and 35.4 ± 12.7 years (range: 17–40 years), respectively. No significant difference between the two groups with respect to age and gender was observed. In this study, patients were 80 males and 40 females. The average size of patients' renal stones located in inferior ureter was 5.4 ± 3.1 mm and 5.7 ± 4.02 mm in groups A and B, respectively; the difference was not statistically significant. In our study, aminophylline was locally administrated during TUL; it was related to benefit response rate. Success rate of stone removal in case group was 95% compared with 71.6% in control group. The postoperative stent was required in only 8 patients of case group compared with 11 in control group. No significant side effects were observed in the patients treated with aminophylline. In our study, only 6 patients in case group (compared to 33 in control group) required double J catheter after TUL; this might be related to antispasm effects of aminophylline on ureter. It is established that pharmacological treatment may affect ureteral movement and treatment of renal colic; it can facilitate retrograde access to the ureter and improvement in cleanup of stone or its parts. Source: http://doi.org/10.1155/2012/727843