Prospective study comparing Rowatinex, Alfuzosin and treatment with both for lower ureteral stones Faragi G.(1), Mullerad M. (1,2), Rub R. (1), Gremitsky A. (1), Jolkowsky E. (1), Marazka H. (1), Erlich N. (1) 1- Hillel Yaffe Medical Center, Dept. of Urology, Hadera, Israel; 2- Laniado Hospital-Sanz Medical Center, Urology Service, Dept. of Surgery, Netanya, Israel Background Materials and Methods
Conservative treatment of lower ureteral stones is a
Between the years 2004-2007, 67 patients (average and mean
Stone expulsion rate was 84% at one month (56 patients).
preferred option for small non obstructing or impacted
age 44 and 43 years, 55 men, 12 women) diagnosed with
Kaplan Meier curve demonstrated a significant better stone
stones. Pharmacotherapy aimed to enhance stone expulsion
expulsion rate in the combined treatment arm (log rank test
rates had been previously studied. Alpha-blockers can be
Institutional review board approved the study. All patients
P=0.002). Multivariate analysis found only the type of
used as muscle relaxants for the lower urinary tract.
signed an informed consent. Patients were assigned to one of
pharmaceutical treatment and stone size to be associated
Alpha1-adrenergic receptor antagonist have been shown to
3 study arms a. Rowatinex- 12 capsules a day [Pinene
with a stone expulsion event (Cox regression analysis;
greatly increase urinary flow rates for patients with
31%,Camphene 15%,Borneol10%,Ayhenol 4%,Fenchone
symptomatic prostatic hyperplasia. Studies have shown the
4%, Cineol 3%] ; b. Alfuzosin 10 mg a day; c. Combined
presence of alpha1-adrenergic receptors in the distal ureter
and ureterovesical junction, where antagonists are able to
Each patient was followed for one month or until stone
inhibit basal muscle tone, reduce peristaltic frequency, and
expulsion. Confirmation for stone status at the end of follow-
weaken ureteral contractions in the distal and intramural
up was done by the imaging utility that diagnosed the stone.
ureter. Previous studies demonstrated 30% increased
Using student T test we found patients treated with
spontaneous stone passage rates in patients treated with
Rowatinex had significantly smaller stones than patients
Alpha1-adrenergic receptor antagonist for ureterovesical
treated with Alfuzosin. No other significant differences
and distal ureteral stones. Other agents used to facilitate
between the study arms were found (table 1). Kaplan Meier
stone expulsion rates are terpenes. Terpenes are curves and Log rank analysis compared between the study hydrocarbon compounds remedies based on herbal essential
arms. Cox regression analysis allowed identification of
oils extracts. In our study we used the Rowatinex®
different factors associated with stone expulsion rate (Age,
formulation which was previously studied as a treatment for
sex, stone location, stone size, and type of pharmaceutical
treatment). A P value of 0.05 or less designated statistical
Objectives Conclusion
Prospective study to compare the lower ureteral stone
expulsion rate of patients treated with either Trepenes
(Rowatinex) ; Alpha1-adrenergic receptor antagonist
Combined treatment with Alfuzosin and Rowatinex is more
(Alfuzosin) and combined treatment with both drugs.
effective in achieving lower ureteral stone expulsion than treatment with only one drug. Further studies are needed to compare this combination treatment in larger populations. Figure-1
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Prospective study comparing Rowatinex, Alfuzosin and treatment with