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The effect of an herbal agent “Tutukon®” on the spontaneous passage rates of ureteric stones


1 Medistate Kavacık Hospital, Department Of Urology, Istanbul, Turkey
2 Addenbrookes Hospital, Department Of Urology, Cambridge, England
3 Kafkas University, Medical School, Department Of Urology, Kars, Turkey
4 Health Sciences University, Lutfi Kirdar Hospital, Department Of Urology, Istanbul, Turkey
5 Biruni University, Medical School, Department Of Urology, Istanbul, Turkey


DOI : 10.33719/yud.2023;18-2-1187893
New J Urol. 2023;18(2):108-114
ABSTRACT

ABSTRACT

Objective: The objective of this study is to assess the efficacy of an herbal agent  (Tutukon®)  on the spontaneous passage rates of ureteral calculi 5-10 mm. 

Material and Methods: 96 patients having a single radio-opaque ureteral stone 5-10 mm were randomized into two groups. Group 1 (n = 51) received Tutukon®, 45 mg/day (three times) in addition to the conservative approach and Group 2 patients (n = 45) were followed with the classical conservative approach during 4 weeks of follow-up. The stone passage rates, stone expulsion time, change in weekly colic episodes and hospital readmission rates for colicky pain were compared.

Results: Stone expulsion rates showed a statistically significant difference between the two groups (66.7 % vs 46.7 %, p = 0.048). Additionally mean time period required for the spontaneous passage of the calculi was meaningfully short in those cases receiving Tutukon® when compared with Group 2 patients undergoing conservative measures only (5.79 ± 2.39 vs 8.82 ± 3.48 days, respectively) (p = 0.001). Similarly, the mean renal colic episodes during the follow-up period were significantly diminished in Group 1 patients (66.6 vs 36%, p = 0.001, respectively). Lastly, colic pain attacks were noted to be less in Group 1, and another advantage of“Tutukon®” was the relocation of the stones to a more distal part of the ureter (35.2 vs 4 %).

Conclusion: Use of Tutukon® in the medical management of ureteral calculi can accelerate the spontaneous passage rates and also relocate them into the lower portion of the ureter. 

Keywords: Herbal agents; medical therapy; spontaneous passage; ureteral stones

ABSTRACT

Objective: The objective of this study is to assess the efficacy of an herbal agent  (Tutukon®)  on the spontaneous passage rates of ureteral calculi 5-10 mm. 

Material and Methods: 96 patients having a single radio-opaque ureteral stone 5-10 mm were randomized into two groups. Group 1 (n = 51) received Tutukon®, 45 mg/day (three times) in addition to the conservative approach and Group 2 patients (n = 45) were followed with the classical conservative approach during 4 weeks of follow-up. The stone passage rates, stone expulsion time, change in weekly colic episodes and hospital readmission rates for colicky pain were compared.

Results: Stone expulsion rates showed a statistically significant difference between the two groups (66.7 % vs 46.7 %, p = 0.048). Additionally mean time period required for the spontaneous passage of the calculi was meaningfully short in those cases receiving Tutukon® when compared with Group 2 patients undergoing conservative measures only (5.79 ± 2.39 vs 8.82 ± 3.48 days, respectively) (p = 0.001). Similarly, the mean renal colic episodes during the follow-up period were significantly diminished in Group 1 patients (66.6 vs 36%, p = 0.001, respectively). Lastly, colic pain attacks were noted to be less in Group 1, and another advantage of“Tutukon®” was the relocation of the stones to a more distal part of the ureter (35.2 vs 4 %).

Conclusion: Use of Tutukon® in the medical management of ureteral calculi can accelerate the spontaneous passage rates and also relocate them into the lower portion of the ureter. 

Keywords: Herbal agents; medical therapy; spontaneous passage; ureteral stones

INTRODUCTION

INTRODUCTION

7 - 10 % of the population suffers from urolithiasis and related problems1,2. Ureteric stones should be detected and removed as quickly as possible to prevent obstruction and the associated discomfort of colic. This is the case regardless of where the calculus is located in the urinary system (3,4).

Although the likelihood of spontaneous passage of larger ureteral stones (> 10 mm) is decreased, in asymptomatic cases without obstruction, a conservative approach with pain management and medical expulsive therapy (MET) are reasonable options. Also, compared to minimally invasive surgical procedures, these approaches are safer and less expensive (2). Conservative management, including the use of MET when there is adequate evidence (5,6) is recommended by both the EAU and the AUA guidelines.

As a herbal agent, Tutukon® (Laboratorio Miguel&Garriga, S.A. Barcelona, Spain) is composed of eight different plants. Components of the medication individually show anti-apoptotic, nephroprotective, antioxidant, anti-apoptotic, and spasmolytic effects(7,8). The diuretic, spasmolytic, and anti-inflammatory actions of plant extracts from Opuntia ficus indica (9), Rosmarinus officinales (10), and Cynodon dactylon11 have all been studied for their potential effects on stone formation.

The present study aimed to investigate the possible effects of an herbal agent, “Tutukon®” on the spontaneous passage rates of ureteral stones and related factors.

INTRODUCTION

7 - 10 % of the population suffers from urolithiasis and related problems1,2. Ureteric stones should be detected and removed as quickly as possible to prevent obstruction and the associated discomfort of colic. This is the case regardless of where the calculus is located in the urinary system (3,4).

Although the likelihood of spontaneous passage of larger ureteral stones (> 10 mm) is decreased, in asymptomatic cases without obstruction, a conservative approach with pain management and medical expulsive therapy (MET) are reasonable options. Also, compared to minimally invasive surgical procedures, these approaches are safer and less expensive (2). Conservative management, including the use of MET when there is adequate evidence (5,6) is recommended by both the EAU and the AUA guidelines.

As a herbal agent, Tutukon® (Laboratorio Miguel&Garriga, S.A. Barcelona, Spain) is composed of eight different plants. Components of the medication individually show anti-apoptotic, nephroprotective, antioxidant, anti-apoptotic, and spasmolytic effects(7,8). The diuretic, spasmolytic, and anti-inflammatory actions of plant extracts from Opuntia ficus indica (9), Rosmarinus officinales (10), and Cynodon dactylon11 have all been studied for their potential effects on stone formation.

The present study aimed to investigate the possible effects of an herbal agent, “Tutukon®” on the spontaneous passage rates of ureteral stones and related factors.

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