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Almomani HY, Almomani EY, Qablan A, Al-Momany A. Pharmacists' perspectives and perceived barriers to counselling patients with kidney stones. Res Social Adm Pharm 2024; 20:123-133. [PMID: 38462437 DOI: 10.1016/j.sapharm.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND The global increase in kidney stone incidence and its complications emphasise the need for effective management. While pharmacists can play a significant role in counselling and guiding patients, their practices in managing patients with kidney stones remain unclear. OBJECTIVE(S) To explore counselling practices and experiences of pharmacists when dealing with patients with kidney stones and to identify the barriers they face while providing counselling. METHODS A qualitative study was performed using semi-structured phone interviews with pharmacists practising in Jordan. Pharmacists were selected using quota sampling from those who took part in a previous study focused on pharmacists' knowledge of kidney stone aetiology and treatment. The COM-B Model of Behaviour Change was used to develop the interview guide and the analytical framework. Interviews were transcribed verbatim and analysed using a deductive thematic approach based on the pre-specified analytical framework. RESULTS Seven pharmacists (85.7% female; 57.1% working in community pharmacies) were interviewed. Counselling practices of patients with kidney stones were categorised into five themes: (1) Pharmacists' beliefs about patient counselling: perceived importance and desire to improve health through counselling; (2) Most priority patients: Types of patients mostly counselled; (3) Content of kidney stones-specific counselling: patient assessment and recommendations about kidney stones management; (4) Duration of the counselling sessions: time offered and influencing factors; (5) Barriers to patient counselling: patient-related, and pharmacist- and doctor-related challenges. CONCLUSIONS Pharmacists recognise the crucial role of kidney stones counselling but face gaps in their practices, including incomplete dietary education, limited knowledge of medication prescriptions, inconsistent patient-specific approaches, and potential communication challenges. These gaps can be overcome by enhancing training, standardising protocols of kidney stone treatment, promoting interprofessional communication, and improving communication strategies. Future research, including quantitative assessments, is needed to inform strategies that optimise patient counselling practices and facilitate improved outcomes.
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Affiliation(s)
- Huda Y Almomani
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan.
| | - Ensaf Y Almomani
- Department of Basic Medical Sciences, Faculty of Medicine, Al-Balqa Applied University, Al-Salt, Jordan
| | - Ahmad Qablan
- Department of Curriculum and Methods of Instruction, United Arab Emirates University, Al Ain, United Arab Emirates; Faculty of Educational Sciences, Hashemite University, Zarqa, Jordan
| | - Abass Al-Momany
- Department of Clinical Laboratory Sciences, University of Jordan, Amman, Jordan
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Segall M, Mousavi A, Eisner BH, Scotland K. Pharmacologic treatment of kidney stones: Current medication and pH monitoring. Actas Urol Esp 2024; 48:11-18. [PMID: 38043680 DOI: 10.1016/j.acuroe.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
Nephrolithiasis is a globally prevalent urologic condition associated with significant morbidity and patient discomfort. Current management of kidney stones includes both surgical and pharmacologic interventions. Though surgery may be necessary under certain circumstances, pharmacologic treatment is a more affordable, readily available, and a less invasive option for patients. A comprehensive scoping review was conducted to summarize the available literature on the pharmacologic strategies for managing the predominant stone types including calcium oxalate, calcium phosphate, uric acid, struvite, and cystine stones. Central to these therapeutic approaches is the regulation of factors such as urine pH, stone crystallization, and patient metabolics that precipitate stone development and growth. This review highlights the pharmacological options available for treating each kidney stone type, emphasizing the importance of patient tailored medical management that should be considered by every physician.
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Affiliation(s)
- M Segall
- Escuela de Medicina Albert Einstein, Bronx, NY, USA
| | - A Mousavi
- Departamento de Urología, Escuela de Medicina David Geffen, Universidad de California, Los Ángeles, CA, USA
| | - B H Eisner
- Servicio de Urología, Hospital General de Massachusetts, Boston, MA, USA
| | - K Scotland
- Departamento de Urología, Escuela de Medicina David Geffen, Universidad de California, Los Ángeles, CA, USA.
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Jayman J, Gibbs H, Mathias R, Epelman M, Ellsworth P. Progression of asymptomatic nephrolithiasis in children: How often should patients receive follow-up ultrasound imaging? J Pediatr Urol 2022; 18:25.e1-25.e8. [PMID: 34756785 DOI: 10.1016/j.jpurol.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The natural history of asymptomatic nephrolithiasis (AN) in children is not well defined. Furthermore, there is no guidance on the utility of repeated renal ultrasound evaluations in this same population. Follow-up ultrasound studies are often obtained as frequently as every 6 months. The goal of this study is to assess the follow-up ultrasound interval in the management of these patients. METHODS A retrospective IRB approved chart review was performed for patients seen for non-cysteine AN between 2012 and 2019. AN was defined as patients without obstructive uropathy abdominal, flank pain and/or gross hematuria. Asymptomatic stones were discovered incidentally or after an acute stone event. Patients with pre-existing renal anomalies and the timepoints with stone passage or stone procedure were excluded. Descriptive statistics were used for demographic information. Multiple linear regression was used to analyze risk factors. Statistical significance was set to p < 0.05. RESULTS Twenty-nine patients had 90 ultrasounds. The average age at diagnosis was 10.8 ± 6.2 years. The average number of ultrasound studies per patient was 3.2 ± 1.7. The median time between follow-up ultrasounds was 5.2 months [IQR 2.8-10.0]. Median follow-up of patients was 10.6 months [IQR 4.9-21.9]. The change in total stone burden occurred at a rate of 0.11 mm/month (CI [-0.06-0.28], p = 0.20, r2 = 0.42) or 0.66 mm/6 months. Patients with more renal stones had almost a threefold increase in stone burden compared to patients with fewer renal stones (2.98 [CI 1.34-4.62], p=0.001, r2=0.33). Patients with a family history of stones had a twofold increase in the size of their largest stone when compared to patients without a family history (1.97 [CI 0.26-3.68], p=0.02, r2=0.60. CONCLUSION A complex interplay of multiple factors influence the progression of AN in children. Children with a greater number of stones have a higher increase in total stone burden and children with a family history of stones have a faster increase in largest stone size. These patients may require more frequent imaging studies. The small change in stone size over time favors a longer than 6-month interval for many children.
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Affiliation(s)
- John Jayman
- University of Central Florida School of Medicine, Orlando, FL, USA
| | - Hannah Gibbs
- University of Central Florida School of Medicine, Orlando, FL, USA
| | - Robert Mathias
- Division of Nephrology, Nemours Children's Hospital, Nemours Healthcare System, Orlando, FL, USA
| | - Monica Epelman
- Division of Radiology, Nemours Children's Hospital, Nemours Healthcare System, Orlando, FL, USA
| | - Pamela Ellsworth
- Division of Pediatric Urology, Nemours Children's Hospital, Nemours Healthcare System, Orlando, FL, USA.
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Manzo BO, Cabrera JD, Emiliani E, Sánchez HM, Eisner BH, Torres JE. Impact of the adherence to medical treatment on the main urinary metabolic disorders in patients with kidney stones. Asian J Urol 2021; 8:275-279. [PMID: 34401334 PMCID: PMC8356059 DOI: 10.1016/j.ajur.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/06/2020] [Accepted: 06/01/2020] [Indexed: 10/27/2022] Open
Abstract
Objective To assess the effect of the adherence to medical treatment on urinary parameters in the 24-h metabolic study of patients with kidney stones. Methods A retrospective, longitudinal, descriptive, and observational study was carried out by reviewing the hospital electronic medical record from 2014 to 2018. The adherence to drug treatment was measured 6 months after its initiation, and the numerical values of the metabolic studies were compared. Wilcoxon tests were performed to compare the difference before and after treatment. Results Ninety patients were evaluated, with 73.3% of adherence. The 180-day overall adherence rate was 61.2% in patients treated with a single drug and 85.4% in patients treated with multiple drugs. There is a statistically significant increase in citrate levels in patients with good adherence in comparison with non-adherent patients (p=0.031 vs. p=0.528). Conclusions Medical treatment and dietary measures in patients with kidney stones have an initial impact at 6 months on the values of the main urinary metabolic alterations that predispose to calculi formation; the most significant is seen in those patients with adherence to medical treatment for hypocitraturia.
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Affiliation(s)
- Braulio Omar Manzo
- Urology Department, Hospital Regional de Alta Especialidad del Bajío, Blvd. Milenio #130, Col. San Carlos la Roncha, León, Guanajuato, Mexico
| | - Jose David Cabrera
- Urology Department, Hospital Regional de Alta Especialidad del Bajío, Blvd. Milenio #130, Col. San Carlos la Roncha, León, Guanajuato, Mexico
| | - Esteban Emiliani
- Urology Department, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Hector Manuel Sánchez
- Urology Department, Hospital Regional de Alta Especialidad del Bajío, Blvd. Milenio #130, Col. San Carlos la Roncha, León, Guanajuato, Mexico
| | - Brian Howard Eisner
- Urology Department, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Jose Ernesto Torres
- Urology Department, Hospital Regional de Alta Especialidad del Bajío, Blvd. Milenio #130, Col. San Carlos la Roncha, León, Guanajuato, Mexico
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Ju M, Yu X, Wu W, Qu J, Zheng J. Efficacy of combination terazosin and nifedipine therapy in postoperative treatment of distal ureteral stones after transurethral ureteroscopic lithotripsy. J Int Med Res 2020; 48:300060520904851. [PMID: 32237945 PMCID: PMC7132568 DOI: 10.1177/0300060520904851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Methods Results Conclusion
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Affiliation(s)
- Min Ju
- Department of Urology, The First Hospital of China Medical University, Shenyang, China
| | - Xiuyue Yu
- Department of Urology, The First Hospital of China Medical University, Shenyang, China
| | - Weiwei Wu
- Department of Urology, The First Hospital of China Medical University, Shenyang, China
| | - Jingkun Qu
- Department of Urology, The First Hospital of China Medical University, Shenyang, China
| | - Jin Zheng
- Department of Urology, The First Hospital of China Medical University, Shenyang, China
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Compound Characterization and Metabolic Profile Elucidation after In Vitro Gastrointestinal and Hepatic Biotransformation of an Herniaria hirsuta Extract Using Unbiased Dynamic Metabolomic Data Analysis. Metabolites 2020; 10:metabo10030111. [PMID: 32188118 PMCID: PMC7142424 DOI: 10.3390/metabo10030111] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 01/12/2023] Open
Abstract
Herniaria hirsuta L. (Caryophyllaceae) is used for treatment of urinary stones and as a diuretic. Little is known about the active compounds and the mechanism of action. The phytochemical composition of H. hirsuta was comprehensively characterized using UHPLC-UV-HRMS (Ultrahigh-Performance Liquid Chromatography-Ultraviolet-High Resolution Mass Spectrometry) data. An in vitro gastrointestinal model was used to simulate biotransformation, which allowed the monitoring of the relative abundances of individual compounds over time. To analyze the longitudinal multiclass LC-MS data, XCMS, a platform that enables online metabolomics data processing and interpretation, and EDGE, a statistical method for time series data, were used to extract significant differential profiles from the raw data. An interactive Shiny app in R was used to rate the quality of the resulting features. These ratings were used to train a random forest model. The most abundant aglycone after gastrointestinal biotransformation was subjected to hepatic biotransformation using human S9 fractions. A diversity of compounds was detected, mainly saponins and flavonoids. Besides the known saponins, 15 new saponins were tentatively identified as glycosides of medicagenic acid, acetylated medicagenic acid and zanhic acid. It is suggested that metabolites of phytochemicals present in H. hirsuta, most likely saponins, are responsible for the pharmaceutical effects. It was observed that the relative abundance of saponin aglycones increased, indicating loss of sugar moieties during colonic biotransformation, with medicagenic acid as the most abundant aglycone. Hepatic biotransformation of this aglycone resulted in different metabolites formed by phase I and II reactions.
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Évaluation de l’effet antilithiasique, oxalo-calcique et phospho-ammoniaco-magnésien d’extrait aqueux d’ Erica multiflora L. Prog Urol 2017; 27:1058-1067. [DOI: 10.1016/j.purol.2017.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 07/18/2017] [Accepted: 09/26/2017] [Indexed: 11/18/2022]
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Torricelli FCM, Monga M, Marchini GS, Srougi M, Nahas WC, Mazzucchi E. Semi-rigid ureteroscopic lithotripsy versus laparoscopic ureterolithotomy for large upper ureteral stones: a meta - analysis of randomized controlled trials. Int Braz J Urol 2017; 42:645-54. [PMID: 27564273 PMCID: PMC5006758 DOI: 10.1590/s1677-5538.ibju.2015.0696] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 01/19/2016] [Indexed: 12/16/2022] Open
Abstract
Introduction: To provide a systematic review and meta-analysis of randomized controlled trials (RCT) comparing semi-rigid ureteroscopic lithotripsy (URS) with laparoscopic ureterolithotomy (LU) for the treatment of the large proximal ureteral stone. Materials and methods: A systematic literature review was performed in June 2015 using the PubMed, Scopus, and Web of Science databases to identify relevant studies. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria. Results: Six RCT including 646 patients were analyzed, 325 URS cases (50.3%) and 321 LU cases (49.7%). URS provided a significantly shorter operative time (weighted mean difference [WMD] = −31.26 min; 95%CI −46.88 to −15.64; p<0.0001) and length of hospital stay (WMD = −1.48 days; 95%CI −2.78 to −0.18; p=0.03) than LU. There were no significant differences in terms of overall complications (OR = 0.78; 95%CI 0.21-2.92; p=0.71) and major complications – Clavien ≥3 – (OR = 1.79; 95%CI 0.59-5.42; p=0.30). LU led to a significantly higher initial stone-free rate (OR = 8.65; 95%CI 4.18-17.91; p<0.00001) and final stone-free rate (OR = 6.41; 95%CI 2.24-18.32; p=0.0005) than URS. There was a significantly higher need for auxiliary procedures in URS cases (OR = 6.58; 95%CI 3.42-12.68; p<0.00001). Conclusions: Outcomes with LU for larger proximal ureteral calculi are favorable compared to semi-rigid URS and should be considered as a first-line alternative if flexible ureteroscopy is not available. Utilization of flexible ureteroscopy in conjunction with semi-rigid ureteroscopy may impact these outcomes, and deserves further systematic evaluation.
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Affiliation(s)
- Fabio C M Torricelli
- Departamento de Urologia do Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina São Paulo, SP, Brasil.,Stevan B. Streem Center for Endourology & Stone Disease; Glickman Urological & Kidney Institute, The Cleveland Clinic, Cleveland, OH, USA
| | - Manoj Monga
- Stevan B. Streem Center for Endourology & Stone Disease; Glickman Urological & Kidney Institute, The Cleveland Clinic, Cleveland, OH, USA
| | - Giovanni S Marchini
- Departamento de Urologia do Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina São Paulo, SP, Brasil
| | - Miguel Srougi
- Departamento de Urologia do Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina São Paulo, SP, Brasil
| | - William C Nahas
- Departamento de Urologia do Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Departamento de Urologia do Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina São Paulo, SP, Brasil
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Wu SY, Chen HY, Tsai KS, Chiang JH, Muo CH, Sung FC, Chen YH, Chen WC. Long-Term Therapy With Wu-Ling-San, a Popular Antilithic Chinese Herbal Formula, Did Not Prevent Subsequent Stone Surgery: A Nationwide Population-Based Cohort Study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2016; 53:53/0/0046958016681148. [PMID: 27932514 PMCID: PMC5798738 DOI: 10.1177/0046958016681148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/16/2016] [Accepted: 10/22/2016] [Indexed: 12/17/2022]
Abstract
Traditional Chinese herbal medicine (CHM), which is widely used to treat pain and urolithiasis, is a promising therapy for urinary stone prevention. This study investigated the clinical efficacy of a popular CHM, Wu-Ling-San (WLS), in Taiwan for the prophylaxis of recurrent nephrolithiasis as assessed by surgical stone treatment via a nationwide population-based cohort study. The National Health Insurance Research Database, 2000–2010, which included one million patient records. All patients diagnosed with stone disease at the beginning of the study. The matched controls (4-fold the number of WLS patients) were stone patients who did not take WLS. Data analysis included the stone surgeries following the first treatment. We enrolled 11 900 patients with stone disease, and the incidence of stone patients in this database was 1.19%. The prevalence of comorbidities such as benign prostate hyperplasia, chronic kidney disease, diabetes mellitus, and urinary tract infection, but not hypertension, was significantly higher in WLS users. Several patients in both groups were prescribed potassium citrate. The stone treatment rate was significantly higher in WLS users (17.85%) than in the non-WLS users (14.47%). WLS users with an associated comorbidity had a higher treatment rate than the non-WLS users: 21.05% versus 16.70%, respectively. The surgery rate for upper urinary tract stones was higher in WLS users than in the non-WLS users (adjusted hazard ratio, 1.28; 95% confidence interval, 1.08-1.52; P < .05). The stone treatment rate (52.79%) was significantly higher in patients who used a very high amount of WLS (adjusted hazard ratio, 3.02; 95% confidence interval, 2.30-3.98). Stone patients using a high amount of WLS use had a high stone surgical rate. Long-term therapy with WLS did not have a preventive effect on stone surgical treatment. Long-term potassium citrate therapy as a preventive measure appeared to be underutilized in this study.
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Affiliation(s)
| | | | - Kao-Sung Tsai
- China Medical University, Taichung, Taiwan.,Hungkuang University, Taichung, Taiwan
| | | | | | | | - Yung-Hsiang Chen
- China Medical University, Taichung, Taiwan.,Asia University, Taichung, Taiwan
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Arrabal-Martín M, González-Torres S, Cano-García MDC, De Haro-Muñoz T, Abad-Menor F, Arrabal-Polo MÁ, Cózar-Olmo JM. Urine Calcium and Bone Mineral Density in Calcium Stone-Forming Patients Treated with Alendronate and Hydrochlorothiazide. Urol Int 2016; 97:292-298. [DOI: 10.1159/000443484] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/16/2015] [Indexed: 11/19/2022]
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Do α-Blockers Expedite Ureteral Stone Passage? Ann Emerg Med 2016; 67:117-8. [DOI: 10.1016/j.annemergmed.2015.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Indexed: 11/20/2022]
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Editorial comment. Urology 2013; 83:510.e16. [PMID: 24360071 DOI: 10.1016/j.urology.2013.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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