5 Int e r v i e w Tablet in the Management of Urolithiasis Doctor, what preexisting medical conditions can trigger urolithiasis? Preexisting medical conditions such as chronic kidney disease, hypertension, gout, type 2 diabetes mellitus (T2DM), hyperlipidemia, obesity, hyperthyroidism, and certain malignancies can increase the risk of development of renal calculi. Conditions such as obesity, hyperlipidemia, and T2DM are more specifically associated with the formation of calcium oxalate and uric acid stones. What are the symptoms associated with urolithiasis? Urolithiasis typically presents with sudden, severe flank or back pain on one side of the body that can radiate to the groin and may result in blood in the urine, pain while urinating, increased frequency of urination, fever and chills, and nausea and vomiting. What are the causative factors for the formation of different types of urinary calculi? The chemical composition of urinary calculi depends on the abnormalities in urine composition. The process of renal stone formation depends on the urinary pH and chemical composition of the supersaturated urine. Urinary pH of 5.0 to 6.5 promotes calcium oxalate stone formation, urinary pH of > 7.5 promotes calcium phosphate stone formation, and urinary pH of < 5.05 promotes uric acid stone formation. Can dietary habits influence urolithiasis? Yes, diet can strongly influence the formation of renal calculi. Low intake of vitamin A and high intake of animal protein, vitamin D, sodium, refined sugars, and oxalate-rich foods (eg, beans, berries, coffee, chocolate, soda, spinach, and potatoes) can lead to the formation of renal calculi. Low fluid intake and frequent alcohol intake can lead to systemic dehydration that results in the development of urolithiasis. Doctor, can urolithiasis reoccur? What measures can be taken to avoid urolithiasis relapse? Yes, urolithiasis can reoccur. The recurrence rate is higher in men than women. Urolithiasis can reoccur during pregnancy and in patients with obesity and those with a family history of renal calculi. It is, thus, imperative to drink plenty of fluids, eat a balanced diet, avoid excess salt intake, and consume only moderate amounts of dairy products to reduce the risk of urolithiasis relapse. In obese patients, moderate physical activity and weight management to achieve a healthy BMI help reduce the risk of relapse. Doctor, what do you prescribe to your patients for the management of urolithiasis? In addition to lifestyle and dietary modifications, I generally prescribe Cystone forte tablet, an Ayurvedic proprietary formulation from Himalaya Wellness Company, for the comprehensive management of urolithiasis. Cystone forte tablet helps in the expulsion of large calculi and relieves associated obstructive symptoms, such as frequency of micturition, hematuria, and pain, and postlithotripsy complications. Dr Mahendra Singh Punia, MS, MCh (Urology) Senior Consultant Capital Urology and Dental Clinic F-87, Ram Path, Shyam Nagar Sodala, Jaipur 302019, Rajasthan India In the management of large kidney stones… Cystone® forte Expels kidney stones and prevents recurrence ( TA B L E T ) START with for a minimum of 4 weeks For the e ective management of urolithiasis... FORTE Advantage • Faster dissolution • Offers quick relief • Reduces recurrence • Treats large kidney stones • Economical Dosage 2 tablets twice daily. Indications • Urolithiasis (urinary stones up to 12 mm) and crystalluria • For the management of post-lithotripsy complications ® Regd. Trademark Cystone forte Expels kidney stones and prevents recurrence An open-label study was conducted to evaluate the efficacy and safety of Cystone forte tablet in the management of urolithiasis. A total of 65 patients (aged 18–50 y) with renal stones measuring > 5 and < 12 mm were prescribed Cystone forte at a dosage of 2 tablets, BID, for 3 months. Patients were evaluated for calculi size, and clinical symptoms such as colicky pain at the loin, pain in the abdomen, hematuria, dysuria, nausea/vomiting, pain on micturition, tenderness in kidney–urethra–bladder (KUB) area, fever and chills, and loss of appetite. Treatment with Cystone forte resulted in a significant reduction in calculi size from 6.82 ± 2.03 to 2.91 ± 2.31 mm (P < .0001) and a decrease in the presence of renal calculi. After the treatment, 6 patients reported that the stone evacuated and the symptoms reduced by the end of month 1. Expulsion of renal calculi of 5 to 6.9 mm was observed in 20 of 35 patients; expulsion of renal calculi of 7 to 12 mm was observed in 16 of 30 patients (Figure). Symptoms such as colicky pain at the loin, pain in the abdomen, hematuria, dysuria, nausea/vomiting, pain on micturition, tenderness in the KUB area, fever and chills, and loss of appetite were relieved in most of the patients by the end of the study. No serious adverse effects were reported. Hence, the study concluded that Cystone forte is safe and effective in the management of urolithiasis. Source: Palaniyamma D, Jeyaraman R. J Urol Res. 2017;4(4):1093. ames with tagline ION) ith tagline 30 16 35 20 Before Treatment Complete Expulsion of Kidney Stones Size of Calculi: 7 to 12 mm Before Treatment Complete Expulsion of Kidney Stones Size of Calculi: 5 to 6.9 mm Figure. Effect of Cystone forte on the Expulsion of Renal Calculi
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