Mechanical Percussion, Inversion and Diuresis for Residual Lower Pole Fragments After Shock Wave Lithotripsy: A Prospective, Single Blind, Randomized Controlled Trial

Pace, Kenneth T.; Tariq, Nauman; Dyer, Sarah; Weir, Michael J.; Honey, R. John D'a.

doi:10.1016/s0022-5347(05)65507-3

Cited by 108 publications

(61 citation statements)

References 24 publications

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“…Percussion, diuresis and inversion have been shown to increase its success. 23 Therefore, upper pole renal stones if less than 20mm deserve a trial of SWL as initial management. Stones greater than 20mm will usually require PCNL.…”

Section: Stones In the Kidneymentioning

confidence: 99%

Management of renal Stones for the non-specialist

Wilson¹,

Folkard²,

Somani³

2018

IJFCM

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Risk factors for stone formation are categorized into intrinsic and extrinsic causes. Intrinsic causes include age, family history and sex. The peak age of presentation is 40-60 years old. Patients with a first degree relative with renal stones have an increased risk (RR 2.5). 3The relative risk between men and women has narrowed over the past decade from 3:1 to 1.3:1 (ibid). Obesity, fluid intake and diet are the most important extrinsic risk factors. There is a strong correlation between BMI and stone formation. A BMI of >27.5 doubles the relative risk compared with a BMI of 20-22.5. 4 Fluid intake is inversely correlated with stone formation. Consuming >2500 mls/day halves the relative risk compared with <1250 mls/day. 5 A low meat intake (<50g/day) halves the risk of stone formation compared with a high meat intake (>100g/day). 4 Perversely a low, rather than high, calcium diet predisposes to calcium stone formation. 5 PresentationThe majority of renal stones remain asymptomatic. Up to 5% of abdominal ultrasounds and CTs find incidental renal stones.6 Small non-obstructing stones within the kidney are typically asymptomatic or have mild symptoms. The most common presentation of a renal stone is loin pain caused by ureteric obstruction. The classical presentation is severe colicky pain which reaches its peak within 1-2 hours and then becomes constant. Hospital presentation within 12 hours of onset of the pain is a significant predictor of renal colic.7 The location of the stone within the ureter determines the nature of the pain. The most common sites are the pelvico-ureteric junction (PUJ), the pelvic brim and vesico-ureteric junction. PUJ stones typically present with a deep loin pain without radiation, pelvic brim stones with flank or lower quadrant pain radiating into the groin and vesico-ureteric stones with irritative voiding symptoms. Flank pain is not specific to renal stones with stones being demonstrated on CT in 34-73% of these patient. Nausea, vomiting and a change in appetite are present in approximately 50% of cases.7 Other less common symptoms of renal stones include visible haematuria, recurrent urinary tract infections and the painless passage of grit. On examination, loin tenderness may be present in up to 86% of patients.7 Flank and iliac fossa tenderness may be palpated, but there should be no signs of peritonitis. A thorough examination of patient should be performed to rule out the red flags and other differentials mentioned below. InvestigationsDetection of haematuria on urine dipstick is the most discriminating bedside investigation. It has a sensitivity for renal stones of 84%, specificity of 48%, PPV of 72% and NPV of 65%.8 It should be noted that the sensitivity is 95% on day 0 from the onset of pain but decreases to 65% by day 3.9 Low dose non-contrast-enhanced CT (CT KUB) is the gold-standard investigation for most adults, with a sensitivity and specificity of 95% and 98%.9,10 All renal stone types are detectable by CT KUB except for Indinavir stones. These rare stones form as a...

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Section: Stones In the Kidneymentioning

confidence: 99%

Management of renal Stones for the non-specialist

Wilson¹,

Folkard²,

Somani³

2018

IJFCM

View full text Add to dashboard Cite

show abstract

“…Investigators tried to increase stone-free rates in lower calyceal stones with some maneuvers, such as controlled inversion therapy with percussion after SWL or irrigation during treatment (4,5).When outcomes of these auxiliary procedures accompanying SWL were classified by stone size (< 1 cm diameter, 1-2 cm, and > 2 cm),stonefree rates after SWL treatment were found 74%, 56% and 33% respectively (8). Contrast opinions also were reported in other studies claiming that controlled inversion therapy did not improve results for people who underwent shock wave lithotripsy for lower pole kidney stones, among them diuresis and inversion did not significantly improve stone free rates in a series (4,9).…”

mentioning

confidence: 99%

The effect of inclined position on stone free rates in patients with lower caliceal stones during SWL session

Çakıroğlu¹,

Sinanoğlu

Taş

et al. 2015

Arch Ital Urol Androl

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Objective: To compare the outcomes of shock wave lithotripsy (SWL) combined with inclined position and SWL alone in patients with lower pole calyx stones. Methods: Seven hundred forty patients who underwent SWL treatment for lower pole renal stones with a total diameter of 2 cm or less were prospectively randomized into two groups. They were comparable in terms of age, sex, and stone diameters. Patients with lower calyceal stones (4-20 mm) were randomized to SWL (368 patients) or SWL with simultaneous inclination (372 patients) with 30o head down Trendelenburg position). Shock wave and session numbers were standardized according to stone size. Additional standardized shock waves were given to patients with stone fragments determined by kidney urinary bladder film and ultrasound at weeks 1, 4, 10. Results: The overall stone free rate (SFR) was 73% (268/368) in patients with SWL alone and 81% (300/372) in SWL with inclination at the end of 12 th week (p = 0.015). No significant adverse events were noted in both treatment groups. Conclusion: Simultaneous inclination of patients during SWL session increase SFR in lower caliceal stones significantly compared to SWL treatment alone.

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“…Inversion treatments after SWL have been tested and some were found quite efficacious [8][9][10] . We present a prospective, non-randomized trial of forced diuresis and inversion during SWL.…”

mentioning

confidence: 99%

Inversion, Hydration and Diuresis during Extracorporeal Shock Wave Lithotripsy: Does It Improve the Stone-Free Rate for Lower Pole Stone Clearance?

et al. 2009

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Objective: It was the aim of this study to assess the efficacy and safety of combined forced hydration and diuresis with limited inversion during shock wave lithotripsy (SWL) by comparing this treatment modality with conventional SWL for lower calyceal nephrolithiasis. Patients and Methods: In this prospective, non-randomized study, we included 100 patients with lower calyceal calculi ≤2 cm. Fifty of them received conventional SWL and the other 50 underwent SWL combined with oral hydration, diuresis and 12° inversion position during SWL. Intravenous urography was performed for all patients prior to their treatment. Patients in both groups were treated on Dornier™ MPL 9000. Blood pressure monitoring was applied during the SWL session. Follow-up was performed the first and the third month after treatment with plain kidney-ureter-bladder X-ray and kidney-ureter-bladder ultrasound. Results: Clinical outcomes were available in 90 patients. Follow-up at 3 months showed that 83.3% of the patients belonging to the study group were rendered stone free, whereas 71.5% were stone free in the control (p > 0.05). Complications were minimal and not statistically significant. Conclusions: Forced diuresis and inversion therapy is very well tolerated; however, the stone-free rate was not significantly improved.

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Mechanical Percussion, Inversion and Diuresis for Residual Lower Pole Fragments After Shock Wave Lithotripsy: A Prospective, Single Blind, Randomized Controlled Trial

Abstract: Mechanical percussion and inversion is a safe and effective treatment option for residual lower caliceal fragments 3 months after shock wave lithotripsy. Nearly 50% of patients become stone-free, and stone burden is decreased by 50% in the remainder.

Cited by 108 publications

References 24 publications

Management of renal Stones for the non-specialist

Management of renal Stones for the non-specialist

The effect of inclined position on stone free rates in patients with lower caliceal stones during SWL session

Inversion, Hydration and Diuresis during Extracorporeal Shock Wave Lithotripsy: Does It Improve the Stone-Free Rate for Lower Pole Stone Clearance?

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