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According to the results of the experiment conducted by the health sciences university Ege University Medical School’s Department of Urology at the Tepecik Training and Research Hospital’s Department of Urology in Turkey for renal calculi (kidney stones), which were shared with the entire world of science at the World Congress of Endourology and published in a scientific article, Gilaburu extract has successfully proven to be effective in 83.7% of human tests conducted. (2018)

UP6-9: Medical expulsive therapy using Gilaburu (Viburnum opulus L.) extract in patients with lower ureteral stone less than 10mm: A prospective randomized study

Volkan Ulker MD FEBU1, Fuat Kızılay MD FEBU2, Orçun Çelik MD FEBU1

Health Sciences University, Tepecik Training and Research Hospital Department of Urology1, Izmir-Turkey

Ege University Medical School, Department of Urology2, Izmir-Turkey

Objectives

Symptomatic urinary tract stones represent the most common urological condition observed by urologists in the emergency setting. Most of the urinary stones are less than 5mm and have a spontanous passage rate up to 98% with conservative treatment only
(1). For stones between 5-10mm, the estimated spontanous passage rate is 47% (2). Medical expulsive therapy (MET) is being recommended to facilitate stone passage in cases where active stone removal is not indicated. In current guidelines on urolithiasis, only α-blockers are recommended in the MET of ureteral stones ≥5mm (3, 4). However, α-blockers have several side-effects (5). Many studies have shown that Gilaburu (Vibernum opulus L.) has antiurolithiatic and antispasmotic effects (6, 7). Gilaburu fruits are considered as a good chlorogenic acid source. Chlorogenic acid probably the main substance in Gilaburu.
We carried out a prospective randomized study and aimed to evaluate the efficacy of Gilaburu extract as a MET for lower ureteral stones >5mm and <10mm.

Methods

Patients who presenting acute pain and diagnosed with non-contrast computed tomography (NCCT) as unilateral ureteral stone between 5-10mm in two centers were enrolled into the study. Patients with severe hydronephrosis or atrophic kidney parenchime, solitary kidney, proximal or multiple ureteral stones, urinary tract infection symptoms, extreme pain, renal detoriation, history of ureteral surgery or spontaneous stone explusion , gastric complaints, uncontrolled diabetes, pregnancy, receiving other medications and non-opaque stones were excluded. Eligible patients were randomized into two groups. The first group received Gilaburu extract 6000mg/day and diclofenac sodium 100mg/day on demand up to 4 weeks. The control group received only diclofenac sodium 100mg/day on demand. All patients were followed with weekly kidney-urinary-bladder (KUB) x-ray. At the end of 4 weeks, the stone status of the patients was confirmed with NCCT. The endpoint was expulsion of the stone or treatment with ureteroscopic stone removal (URS) or extracorporeal shockwave lithotripsy (ESWL) after 4 weeeks. Expulsion rate, mean expulsion time, emergency room admitting, side effects, need for analgesics and need for treatment with URS or ESWL were recorded. The Student’s t-test or Mann–Whitney U-test was used to compare continuous variables between the two groups, and the c2-test was used for categorical variables. P-values less than 0.05 were considered to show significance.

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Results

Among 85 patients, 39 patients in Gilaburu group and 36 patients in the control group completed the study and were taken to the evaluation. There was no difference in age, gender, mean stone size and stone location between the two groups. In Gilaburu group spontaneous expulsion rate was higher, the day of expulsion was earlier, the total analgesic consumption was lower and the need for treatment with URS/ESWL was lower compared to the controls (Table 1). Both groups were comparable in terms of emergency room admitting and side-effects.

Conclusions

The present study found that MET using Gilaburu extract was significantly effective in enchancing the ureteral stone spontanous expulsion rate with less analgesic usage. It was safe and well tolerated by the patients. The Gilaburu extract can be a useful MET agent.

References

1- Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE, Macaluso JN Jr. Ureteral stones clinical guidelines panel summary reporton the management of ureteral calculi. The American Urological Association . J Urol 1997;158(5):1915-1921
2- Preminger GM, Tiselius HG, Assimos:241 DG, Alken P, Buck C, Gallucci M, et al. 2007 guideline for the management of ureteral calculi. J Urol. 2007;178(6)8-34
3- Türk CNA, Petrik A, Seitz C, Skolarikos A, Thomas K. Guidelines on urolithiasis. European Association of Urology, 2018
4- Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, Pace KT, Pais VM Jr, Pearle MS, Preminger GM, Ravzi H, Shah O, Matlaga BR. Surgical Management of Stones: American Urological Association/Endourological Society guideline, PART I. J Urol. 2016;196(4):1153–60
5- Seitz C, Liatsikos E, Porpiglia F, Tiselius HG, Zwergel U. Medical therapy to facilitate the passage of stones: what is the evidence ? Eur Urol 2009;56(3):455-471
6- Ilhan M, Ergene B, Süntar I, Özbilgin S, Çitoğlu G, Keleş H, Altun L, Akkol Küpeli E. Preclinical evaluation of antiurolithiatic activity of Viburnum opulus L.on sodium oxalate-induced urolithiazis rat model. Evid Based Complement Alternat Med 2014;2014:578103
7- Cometa MF, Parisi L, Palmery M, Meneguz A, Tomassini L. In vitro relaxant and spasmolytic effects of constituents from Viburnum prunifolium and HPLC quantification of the bioactive isolated iridoids. J Ethnoparmacol 2009;123(2):201-207