Controlled Inversion Therapy: an Adjunct to the Elimination of Gravity-Dependent Fragments Following Extracorporeal Shock Wave Lithotripsy

Abstract

The retention of passable stone debris is the primary shortcoming of extracorporeal shock wave lithotripsy. Residual stone debris is located almost universally in gravity-dependent caudal calices. Our findings suggest that multiple sessions of controlled inversion therapy could have a beneficial role in the postoperative management of this select group of patients.

Clearance of Lower-Pole Stones following Shock Wave Lithotripsy: Effect of the Infundibulopelvic Angle

“…Several reports have suggested that repeat piezoelectric SWL improves stone-free rates for residual lower-pole calyceal stones [15, 16], but we have shown that so-called ‘stir-up’ treatment with piezoelectric SWL is relatively ineffective, especially in patients with distorted calyces [17]. Other methods to clear the lower pole-calyces of residual fragments include inversion therapy [18]and irrigation with a cobra catheter placed transurethrally [19]. A comparative study of inversion therapy versus controls, however, actually showed a lower stone-free rate in the treatment group [20].…”

Natural History of Residual Renal Stone Fragments after ESWL

“…Some authors have proposed a medical treatment based on the use of alkaline citrate that could promote a significant clearance of RF with time [6]. Other authors recommend a new session of ESWL or a controlled inversion therapy [3, 14, 25, 29]. These different studies are interesting but need to be evaluated by more documented prospective studies.…”

Effect of Lower Infundibulopelvic Angle, Lower Infundibulum Diameter and Inferior Calyceal Length on Stone Formation

“…Although gravity is accused of retention of calculi in lower pole lithiasis, it is not clear why some patients become stone free while others do not [1][2][3]. Anatomical factors effecting clearance of lower calyceal residual fragments after ESWL may also be responsible for stone formation.…”

“…For the same reason there is a high incidence of residual fragments following extracorporeal shock wave lithotripsy (ESWL) to lower calyceal stones [1][2][3]. A new anatomical approach has been put forward by some authors using parameters such as lower infundibulopelvic angle, lower infundibulum diameter and inferior calyceal length to explain renal stone clearance [4][5][6].…”