Forced Diuresis After Flexible Ureteroscopy for Medium-Sized Renal Stones

Ain Shams University2,000 enrolled

Overview

This randomized controlled clinical trial evaluated whether furosemide-assisted forced diuresis during flexible ureteroscopy reduced the residual fragment rate and improved the stone-free rate after flexible ureteroscopy for management of medium sized renal stones measuring up to 30 millimeters. Adult patients undergoing flexible ureteroscopy for renal stones were randomized into two parallel groups: an experimental group that received intravenous furosemide during the procedure and a control group that received standard perioperative and postoperative care without furosemide. Stone-free status and residual fragments were assessed using non-contrast computed tomography performed four weeks after the procedure, and residual fragments were classified by fragment size. Secondary outcomes included operative time, length of hospital stay, postoperative complications, total urine output in the first 24 hours, and the need for additional treatments for significant residual stones.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

2,000

Conditions

Kidney Stones

Interventions

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adult patients aged 18 years or older. * Patients who underwent flexible ureteroscopy for renal stones measuring 30 millimeters or less. Exclusion Criteria: * Patients with active urinary tract infection. * Patients with a history of previous open renal surgery or renal trauma. * Patients with contraindications to anesthesia, such as severe cardiac disease, uncontrolled diabetes mellitus, or severe coagulation disorder. * Patients with severe renal impairment, defined as an estimated glomerular filtration rate less than 30 milliliters per minute per 1.73 square meters. * Patients with a single kidney. * Patients with contraindications to furosemide administration. * Patients with congenital renal anomalies.

Outcomes

Primary Outcomes

Stone-free rate on non-contrast computed tomography

Stone-free status was assessed using non-contrast computed tomography performed four weeks after the procedure. Residual fragments were classified into four grades: Grade A (no stones), Grade B (0 to 2 millimeters), Grade C (2.1 to 4 millimeters), and Grade D (greater than 4 millimeters, clinically significant residual stones).

Time frame: Four weeks after flexible ureteroscopy

Secondary Outcomes

Operative time

Operative time was calculated from insertion of the ureteroscope into the urethra until completion of ureteral stent placement.

Time frame: During procedure

Length of hospital stay

Length of hospital stay was calculated from the day of surgery to the day of discharge.

Time frame: From end of procedure to hospital discharge (up to 7 days)

Postoperative hematuria

Hematuria was recorded after the procedure.

Time frame: From end of procedure through 4 weeks post-procedure

Postoperative urinary tract infection

Postoperative urinary tract infection was assessed within seven days after the procedure using fever with urinary symptoms and or a positive urine culture with significant bacteriuria.

Time frame: Within 7 days post-procedure

Postoperative pain score

Postoperative pain was assessed using a numerical rating scale (NRS) from 0 to 10, where 0 indicates no pain and 10 indicates worst imaginable pain (higher scores = worse pain). Pain was recorded in the recovery room (PACU), on postoperative day 1 (during admission), and at discharge.

Time frame: Recovery room (PACU), postoperative day 1, and at discharge (up to 7 days)

Need for auxiliary treatment for clinically significant residual stones

The need for auxiliary treatment for clinically significant residual stones was recorded, including extracorporeal shock wave lithotripsy or repeat ureteroscopy.

Time frame: Up to four weeks after flexible ureteroscopy