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In Reply: I thank Dr. Keller for his kind letter.
With respect to expulsive therapy, Dellabella et al1 randomly assigned 210 patients to receive nifedipine, tamsulosin, or phloroglucinol. All the patients also received a corticosteroid. The most effective therapy was tamsulosin, though this was not a placebo-controlled study. In a separate study, Borghi et al2 compared methylprednisolone plus nifedipine and methylprednisolone plus placebo. The nifedipine-methylpednisolone combination seemed to result in more prompt stone passage.
With respect to calcium supplements in calcium kidney stone disease, Curhan et al3 prospectively examined stone risk associated with dietary calcium as well as calcium supplements. This seemed to show that with calcium supplements there was no increased risk, and there may have even been some benefit. In another study by Borghi et al,4 normal dietary calcium intake was shown to be associated with lower stone risk than a low calcium intake. Further, the study by Curhan et al3 seemed to indicate the same.
- Dellabella M, Milanese G, Muzzonigro G. Randomized trial of the efficacy of tamsulosin, nifedipine and phloroglucinol in medical expulsive therapy for distal ureteral calculi. J Urol 2005; 174:167–172.
- Borghi L, Meschi T, Amato F, et al. Nifedipine and methylprednisolone
in facilitating ureteral stone passage: a randomized, double blind, placebo-controlled study. J Urol 1994; 152:1095–1098. - Curhan GC, Willett WC, Knight EL, Stampfer MJ. Dietary factors and the risk of incident kidney stones in younger women: Nurses’ Health Study II. Arch Intern Med 2004; 164:885–891.
- Borghi L, Schianchi T, Meschi T, et al. Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. N Engl J Med 2002; 346:77–84.
In Reply: I thank Dr. Keller for his kind letter.
With respect to expulsive therapy, Dellabella et al1 randomly assigned 210 patients to receive nifedipine, tamsulosin, or phloroglucinol. All the patients also received a corticosteroid. The most effective therapy was tamsulosin, though this was not a placebo-controlled study. In a separate study, Borghi et al2 compared methylprednisolone plus nifedipine and methylprednisolone plus placebo. The nifedipine-methylpednisolone combination seemed to result in more prompt stone passage.
With respect to calcium supplements in calcium kidney stone disease, Curhan et al3 prospectively examined stone risk associated with dietary calcium as well as calcium supplements. This seemed to show that with calcium supplements there was no increased risk, and there may have even been some benefit. In another study by Borghi et al,4 normal dietary calcium intake was shown to be associated with lower stone risk than a low calcium intake. Further, the study by Curhan et al3 seemed to indicate the same.
In Reply: I thank Dr. Keller for his kind letter.
With respect to expulsive therapy, Dellabella et al1 randomly assigned 210 patients to receive nifedipine, tamsulosin, or phloroglucinol. All the patients also received a corticosteroid. The most effective therapy was tamsulosin, though this was not a placebo-controlled study. In a separate study, Borghi et al2 compared methylprednisolone plus nifedipine and methylprednisolone plus placebo. The nifedipine-methylpednisolone combination seemed to result in more prompt stone passage.
With respect to calcium supplements in calcium kidney stone disease, Curhan et al3 prospectively examined stone risk associated with dietary calcium as well as calcium supplements. This seemed to show that with calcium supplements there was no increased risk, and there may have even been some benefit. In another study by Borghi et al,4 normal dietary calcium intake was shown to be associated with lower stone risk than a low calcium intake. Further, the study by Curhan et al3 seemed to indicate the same.
- Dellabella M, Milanese G, Muzzonigro G. Randomized trial of the efficacy of tamsulosin, nifedipine and phloroglucinol in medical expulsive therapy for distal ureteral calculi. J Urol 2005; 174:167–172.
- Borghi L, Meschi T, Amato F, et al. Nifedipine and methylprednisolone
in facilitating ureteral stone passage: a randomized, double blind, placebo-controlled study. J Urol 1994; 152:1095–1098. - Curhan GC, Willett WC, Knight EL, Stampfer MJ. Dietary factors and the risk of incident kidney stones in younger women: Nurses’ Health Study II. Arch Intern Med 2004; 164:885–891.
- Borghi L, Schianchi T, Meschi T, et al. Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. N Engl J Med 2002; 346:77–84.
- Dellabella M, Milanese G, Muzzonigro G. Randomized trial of the efficacy of tamsulosin, nifedipine and phloroglucinol in medical expulsive therapy for distal ureteral calculi. J Urol 2005; 174:167–172.
- Borghi L, Meschi T, Amato F, et al. Nifedipine and methylprednisolone
in facilitating ureteral stone passage: a randomized, double blind, placebo-controlled study. J Urol 1994; 152:1095–1098. - Curhan GC, Willett WC, Knight EL, Stampfer MJ. Dietary factors and the risk of incident kidney stones in younger women: Nurses’ Health Study II. Arch Intern Med 2004; 164:885–891.
- Borghi L, Schianchi T, Meschi T, et al. Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. N Engl J Med 2002; 346:77–84.