Preclinical and Clinical Overview of Terpenes in the Treatment of Urolithiasis

Context: Pharmaceutical support for spontaneous stone expulsion therapy or fragment clearance after shock wave lithotripsy (SWL) is standard of care in the daily urologic routine. Besides tamsulosin and calcium-channel antagonists, biological products such as terpen combinations are suggested as promoters of stone expulsion. Objective: To summarize the literature on terpen combinations in the pharmaceutical treatment of urolithiasis. Evidence acquisition: The manuscript is based on a presentation given at a symposium on "Terpenes in urolithiasis" that was held in Dusseldorf, Germany, in 2010. Data were retrieved from critically selected publications. Evidence synthesis: Rowatinex is a combination of seven naturally available terpenes. The pharmaceutical effects of the included terpenes are diuretic, spasmolytic, antibacterial, and hyperemic. Consequently, Rowatinex is considered a valuable medication in the treatment of urolithiasis. Despite a long history of clinical availability for Rowatinex, with >50 yr since product placement, the number of available publications is straightforward; however, four open controlled and five prospective randomized trials are published. The majority of these publications show favorable results for Rowatinex compared with placebo in terms of stone expulsion rate and fragment expulsion after SWL. Rowatinex seems to have a good safety profile, with a low incidence of adverse events, which are mainly of gastroenterologic nature. Conclusions: As a combination of seven naturally available terpenes, Rowatinex seems to have the potential to promote and accelerate stone expulsion in primary management of urolithiasis as well as fragment discharge after SWL. In doing so, Rowatinex shows superior results over placebo in the majority of the published studies. Large-scale randomized trials comparing the effect of Rowatinex versus tamsulosin and calcium-channel antagonists are pending. (C) 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.