A fresh look at oral chemolysis for non symptomatic kidney stones. Potassium citrate and Allopurinol combination. A Prospective Comparative Analysis

Abstract

Abstract PURPOSE: To compare the results of oral chemolysis of nonopaque and semi-opaque kidney stones using potassium citrate (PS) and allopurinol + potassium citrate (ALPS) prospectively without advanced metabolic analysis. MATERIAL and METHODS: Between 2020 and 2022, 47 patients aged 19-60 years with non-obstructive, semi-opaque, and nonopaque kidney stones of 8-13 mm in size detected by non-contrast tomography were prospectively investigated, and oral chemolysis (potassium citrate 10 mEq 2x2, allopurinol 10 mEq 2x2) was initiated. Patients were divided into two groups: potassium citrate (PS) and allopurinol + potassium citrate (ALPS), according to the treatment to be received. The essential characteristics of the groups, monthly laboratory values throughout the process, and the stone size measured by non-contrast tomography at the initial presentation and the control visit were recorded and compared. RESULTS: The most common stone localization was in the inferior calyx. There were no statistically significant differences between the groups regarding age, gender, size, location, or stone side The mean stone size was 11.01±2.27 mm in the PS group and 11.1±2.03 mm in the ALPSS group before treatment. After treatment, a significant change was observed in these values in both groups; however, there was no statistical difference between the groups. (p: <0.001), (p: 0.115) There was a meaningful range in the mean urine pH of all patients after treatment. (p: <0.001), Urea (BUN), creatinine, and glomerular filtration rate (GFR) values did not change significantly in either group. CONCLUSION: Potassium citrate-based urinary alkalisation can be started for nonopaque and semi-opaque kidney stones without metabolic analysis if the urine pH is appropriate. Allopurinol, in combination with potassium citrate, has no therapeutic advantage.