Investigating the effect of prescribing diuretics and the inclined position with the head down for the removal of lower calices stones during extracorporeal shock wave lithotripsy in patients who referred to the Stone Crushing Center

Investigating the effect of simultaneous administration of diuretics and Head Down for the removal of lower calices stones during Extracorporeal shock wave lithotripsy (ESWL)

Equal division of 148 patients into 2 intervention and control groups and permuted block randomization to balance the number of allocated samples.

Receiving 10 mg of Lasix 30 min before ESWL and 1 lit of IV hydration of 0.9% NaCl during the procedure and 20 to 30 degree angulation of the patient to facilitate the removal of stones from the lower calyx to the pelvis and to investigate the simultaneous effect of diuretics and head down to increase SFR during ESWL at Sina Hospital.

inclusion criteria: 1)Age 18 to 60 years 2)lower calyx stones Exclusion criteria: 1)urinary system's anatomical abnormalities 2)Uncorrected coagulation problem 3)Untreated urinary infection or urosepsis 4)Previous urological surgery 5)Obstruction of the urinary tract distal to the stone 6)Unilateral and simultaneous kidney and ureter stones 7)renal failure 8)Suffering from a heart disease such as having a pacemaker 9)tumor in areas exposed to shock 10)Aneurysms 11)Body mass index>40 kg/m2 12)Skeletal problems 13)sensitivity to diuretics 14)Pregnancy 15)single kidney. 16)hypotention 17)uncontrolled hypertention 18)central nervous system diseases. 19) history of increased intracranial pressure

Receiving 10 mg of Lasix 30 minutes before ESWL and 1 lit of IV hydration of 0.9% NaCl during the procedure and 20 to 30 degree angulation of the patient to facilitate stone removal from the lower calyx to the pelvis in the intervention group and not receiving these items in the group the witness

Pain, nausea, hematuria,urinary tract infection,urethral obstruction,dysuria, metabolic disorders headache,dizziness,blurred vision,BP changes

. We use the permuted block randomization method to balance the number of detected samples. For this purpose, we use the site https://www.sealedenvelope.com/simple-randomiser/v1/lists for block randomization and get the following results: Your list Seed: 500000000000000000 Block sizes: 4 Actual list length: 52 block identifier, block size, sequence within block, treatment • 1, 4, 1, Group A • 1, 4, 2, Group B • 1, 4, 3, Group B • 1, 4, 4, Group A • 2, 4, 1, Group A • 2, 4, 2, Group A • 2, 4, 3, Group B • 2, 4, 4, Group B • 3, 4, 1, Group B • 3, 4, 2, Group A • 3, 4, 3, Group A • 3, 4, 4, Group B • 4, 4, 1, Group A • 4, 4, 2, Group B • 4, 4, 3, Group B • 4, 4, 4, Group A • 5, 4, 1, Group B • 5, 4, 2, Group A • 5, 4, 3, Group B • 5, 4, 4, Group A • 6, 4, 1, Group A • 6, 4, 2, Group A • 6, 4, 3, Group B • 6, 4, 4, Group B • 7, 4, 1, Group A • 7, 4, 2, Group B • 7, 4, 3, Group A • 7, 4, 4, Group B • 8, 4, 1, Group A • 8, 4, 2, Group B • 8, 4, 3, Group A • 8, 4, 4, Group B • 9, 4, 1, Group A • 9, 4, 2, Group B • 9, 4, 3, Group A • 9, 4, 4, Group B • 10, 4, 1, Group B • 10, 4, 2, Group B • 10, 4, 3, Group A • 10, 4, 4, Group A • 11, 4, 1, Group A • 11, 4, 2, Group A • 11, 4, 3, Group B • 11, 4, 4, Group B • 12, 4, 1, Group A • 12, 4, 2, Group B • 12, 4, 3, Group A • 12, 4, 4, Group B • 13, 4, 1, Group B • 13, 4, 2, Group B • 13, 4, 3, Group A • 13, 4, 4, Group A And then we can use coin toss to choose between A and B. Also, a questionnaire has been designed to record information, which includes three parts before the operation, during the operation and after the operation, which are included in the appendices.

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The Researcher ( Darya Rezaei ) drrezaei98@gmail.com

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