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Patel N, Roe A, Stanton D, Roberts J, Kothari A. SLAP Trial: Shock Wave Lithotripsy and Mechanical Percussion Therapy Post ESWL for Renal Calculi. Adv Urol 2024; 2024:7870425. [PMID: 38566931 PMCID: PMC10987243 DOI: 10.1155/2024/7870425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/27/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
Methods We conducted a prospective randomised control trial. Included patients were males and females greater than 18 years of age with single or multiple ipsilateral renal calculi of total ≤10 mm on plain X-ray and noncontrast CT KUB. ESWL was performed at a single centre, at supine position under general anaesthesia with maximum 3000 shocks at a rate of 100 shocks per minute. Patients were discharged and randomised to either the control arm or MPI therapy. MPI therapy was self-directed in a home setting for 10 minutes a day, three times per week. Both arms had standard follow-up at 12 weeks with a plain X-ray KUB. Patients in the control group were offered cross over to the MPI arm after 12 weeks if residual stone fragments were detected. Statistical analysis was performed using SPSS software via Chi squared and Fisher's exact tests. Ethical approval was obtained via the Prince Charles Hospital HREC Committee, HREC/2022/QPCH/84961. Results 70 patients met inclusion criteria and underwent ESWL, and 5 were withdrawn. 33 patients were randomised to the MPI group and 32 to the control group. MPI significantly increased the stone clearance rate anywhere in the kidney (87.9% in the MPI group versus 59.4% in the control group, p=0.089), as well as the clearance rate in the lower pole (91.7% in the MPI group versus 63.2% in the control group, p=0.022). Delayed percussion did not improve the clearance rate over primary percussion (p=0.835). Conclusion This study has shown that MPI can be effectively performed in a home setting without the need for medical supervision and results in improved stone clearance rates post ESWL. The main limitations to the study were the use of X-ray over CT during the follow-up and variability in MPI compliance and administration. Further research is warranted into standardising home MPI protocols. This trial is registered with ANZCTR387061.
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Affiliation(s)
- Nishal Patel
- Department of Urology, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Adrian Roe
- Department of Urology, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Donna Stanton
- Department of Urology, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Jay Roberts
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Akshay Kothari
- Department of Urology, The Prince Charles Hospital, Brisbane, Queensland, Australia
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Wang DJ, Liang P, Yang TX, Liu YQ, Tang QL, Zhou XZ, Tao RZ. RIRS with FV-UAS vs. MPCNL for 2-3-cm upper urinary tract stones: a prospective study. Urolithiasis 2024; 52:31. [PMID: 38340165 DOI: 10.1007/s00240-024-01539-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
To observe the efficacy and safety of retrograde intrarenal surgery (RIRS) combined with flexible vacuum-assisted ureteral access sheath (FV-UAS) and minimally invasive percutaneous nephrolithotomy (MPCNL) in patients with 2-3 cm upper urinary tract stones. A total of 160 patients with 2-3 cm upper urinary tract stones were prospectively randomized into 2 groups-80 in the FV-UAS group and 80 cases as control in the MPCNL group. The stone-free rates (SFRs) at different times (postoperative 1st day and 4th week) were considered as the primary outcome of the study. The secondary end points were operative time, hemoglobin decrease, postoperative hospital stay, and operation-related complications. There was no obvious difference between the two groups in patient's demographics and preoperative clinical characteristics (all P > 0.05). Postoperative data showed that mean decrease in hemoglobin level was less in FV-UAS group than that in MPCNL group (5.3 vs. 10.8 g/L, P < 0.001). Postoperative hospital stay in FV-UAS group was more shorten than that in MPCNL group (2.7 vs. 4.9 days, P < 0.001). There was no statistical significance between the two groups in SFRs during postoperative 1st day and 4th week (both P > 0.05). However, in terms of the rates of bleeding and pain, MPCNL group were both significantly higher than FV-UAS group (6.2 vs. 0.0%, P = 0.023; 16.2 vs. 2.5%, P = 0.003; respectively). Our study showed that RIRS with FV-UAS, a new partnership to treat 2-3 cm upper urinary tract stones, was satisfying as it achieved a high SFR rate and a low rate of complications. This method was safe and reproducible in clinical practice.
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Affiliation(s)
- Du-Jian Wang
- The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | | | - Tian-Xiao Yang
- The Affiliated Hospital of Chifeng University, Inner Mongolia, Chifeng, China
| | - Yi-Qing Liu
- Guanyun People's Hospital, Lian Yungang, China
| | - Qing-Lai Tang
- The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Xing-Zhu Zhou
- The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Rong-Zhen Tao
- The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China.
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Qiu M, Zhang T, Zhang Y, Liang T, Chen J, Gao H. Physical Techniques to Remove Residual Stone Fragments in the Urinary System. Urol Int 2023; 108:9-19. [PMID: 38008076 PMCID: PMC10836958 DOI: 10.1159/000535298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/26/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Although significant progress has been made in treatment techniques for renal and ureteral calculi, residual fragments (RF) persisting long after treatment pose a serious threat to patients' health. A variety of novel physical techniques and extraction devices are currently being developed to promote the removal of RF from the urinary system, and a series of in vivo experiments have demonstrated their safety and efficacy. SUMMARY External physical vibration lithecbole, magnetic extraction, biocompatible stone adhesive-based methods, and ultrasonic propulsion technologies are examples of innovative therapies that can promote the clearance of RF and improve the stone-free rate. In conclusion, the physical treatment of these RF needs to be optimized and improved. They are a promising technique for improving the efficiency of endovascular urology, and further in vivo studies are needed to confirm their safety and efficacy. KEY MESSAGES We have summarized the literature on removal of RF by physical methods in recent years, especially the new progress.
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Affiliation(s)
- Minhua Qiu
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
| | - Ting Zhang
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Yingying Zhang
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Taisheng Liang
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Jibing Chen
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Hongjun Gao
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
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Best Practice in Interventional Management of Urolithiasis: An Update from the European Association of Urology Guidelines Panel for Urolithiasis 2022. Eur Urol Focus 2023; 9:199-208. [PMID: 35927160 DOI: 10.1016/j.euf.2022.06.014] [Citation(s) in RCA: 64] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/27/2022] [Accepted: 06/28/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE The European Association of Urology (EAU) has updated its guidelines on clinical best practice in urolithiasis for 2021. We therefore aimed to present a summary of best clinical practice in surgical intervention for patients with upper tract urolithiasis. MATERIALS AND METHODS The panel performed a comprehensive literature review of novel data up to May 2021. The guidelines were updated and a strength rating was given for each recommendation, graded using the modified Grading of Recommendations, Assessment, Development, and Evaluations methodology. RESULTS The choice of surgical intervention depends on stone characteristics, patient anatomy, comorbidities, and choice. For shockwave lithotripsy (SWL), the optimal shock frequency is 1.0-1.5 Hz. For ureteroscopy (URS), a postoperative stent is not needed in uncomplicated cases. Flexible URS is an alternative if percutaneous nephrolithotomy (PCNL) or SWL is contraindicated, even for stones >2 cm. For PCNL, prone and supine approaches are equally safe. For uncomplicated PCNL cases, a nephrostomy tube after PCNL is not necessary. Radiation exposure for endourological procedures should follow the as low as reasonably achievable principles. CONCLUSIONS This is a summary of the EAU urolithiasis guidelines on best clinical practice in interventional management of urolithiasis. The full guideline is available at https://uroweb.org/guidelines/urolithiasis. PATIENT SUMMARY The European Association of Urology has produced guidelines on the best management of kidney stones, which are summarised in this paper. Kidney stone disease is a common condition; computed tomography (CT) is increasingly used to diagnose it. The guidelines aim to decrease radiation exposure to patients by minimising the use of x-rays and CT scans. We detail specific advice around the common operations for kidney stones.
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Miller AW, Penniston KL, Fitzpatrick K, Agudelo J, Tasian G, Lange D. Mechanisms of the intestinal and urinary microbiome in kidney stone disease. Nat Rev Urol 2022; 19:695-707. [PMID: 36127409 PMCID: PMC11234243 DOI: 10.1038/s41585-022-00647-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 02/08/2023]
Abstract
Kidney stone disease affects ~10% of the global population and the incidence continues to rise owing to the associated global increase in the incidence of medical conditions associated with kidney stone disease including, for example, those comprising the metabolic syndrome. Considering that the intestinal microbiome has a substantial influence on host metabolism, that evidence has suggested that the intestinal microbiome might have a role in maintaining oxalate homeostasis and kidney stone disease is unsurprising. In addition, the discovery that urine is not sterile but, like other sites of the human body, harbours commensal bacterial species that collectively form a urinary microbiome, is an additional factor that might influence the induction of crystal formation and stone growth directly in the kidney. Collectively, the microbiomes of the host could influence kidney stone disease at multiple levels, including intestinal oxalate absorption and direct crystal formation in the kidneys.
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Affiliation(s)
- Aaron W Miller
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Kristina L Penniston
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kate Fitzpatrick
- Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - José Agudelo
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Gregory Tasian
- Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dirk Lange
- The Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
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Tang QL, Wang DJ, Zhou S, Tao RZ. Mirabegron in medical expulsive therapy for distal ureteral stones: a prospective, randomized, controlled study. World J Urol 2021; 39:4465-4470. [PMID: 34241685 DOI: 10.1007/s00345-021-03772-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/11/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To observe the efficacy and safety of Mirabegron in patients with distal, ureteral stones ≤ 10 mm. PATIENTS AND METHODS A total of 90 patients with distal ureteral stones ≤ 10 mm were prospectively randomized into two groups. Forty-five cases in the study group and 45 cases as control. The stone-free rates (SFRs) and renal colic episodes between two groups were compared at the 1st, 2nd and 4th week end by imaging examinations. RESULT All of 90 patients were randomly assigned to two groups. In patients with ≤ 5 mm stones, the SFRs in the 1st week (63.6% vs. 33.3%, P = 0.040), the 2nd week (86.4% vs. 54.2%, P = 0.018), and the 4th week (90.9% vs. 66.7%, P = 0.046) after treatment were all significantly higher than that in the control group by the stratification analysis of stone size. Even though SFRs were all higher for patients with > 5 mm stones in study group, there was no statistically significant difference (All P > 0.05). In terms of renal colic episodes, the frequency of occurrence of the study group was significantly lower than that of the control group and need less antalgic. CONCLUSIONS The MET with Mirabegron has a significant role in improve SFR for the patients with distal ureteral stones ≤ 5 mm and no effect in > 5 mm stones. Furthermore, Mirabegron reduces the need for antalgic in ≤ 10 mm stones with low incidence of adverse effects.
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Affiliation(s)
- Qing-Lai Tang
- Nanjing Jiangning Hospital, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
| | - Du-Jian Wang
- Nanjing Jiangning Hospital, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
| | - Shuang Zhou
- Nanjing Jiangning Hospital, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
| | - Rong-Zhen Tao
- Nanjing Jiangning Hospital, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China.
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Tan C, Jiang Y, Song S, Li X, Zhou C. Therapeutic effects of flexible ureteroscopy alone and in combination with external physical vibration on upper urinary tract calculi: a randomized controlled trial. Wideochir Inne Tech Maloinwazyjne 2021; 16:536-542. [PMID: 34691303 PMCID: PMC8512516 DOI: 10.5114/wiitm.2021.106425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/25/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Upper urinary tract calculus is a common disease of the urinary system. AIM To compare the therapeutic effects of flexible ureteroscopy alone and in combination with external physical vibration on upper urinary tract calculi. MATERIAL AND METHODS A total of 146 patients were randomly divided into control and experimental groups (n = 73). The control group received flexible ureteroscopy lithotripsy, and the experimental group underwent the same but combined with external physical vibration. The rate of finding stones in the urine on the day after treatment, clearance rate, components of stones, levels of renal function indices blood urea nitrogen (BUN) and serum creatinine (Scr), and incidence of complications were compared. The stone-free rate during 1-year follow-up was analysed by Kaplan-Meier method. RESULTS The rate of finding stones in the urine on the day after treatment was higher in the experimental group (100%) than that in the control group (29.73%) (p < 0.05). The clearance rates on the day, at 1 week, and at 2 weeks after treatment in the experimental group were 71.23%, 87.67%, and 95.89%, respectively, which surpassed those of the control group at corresponding time points (p < 0.05). BUN and Scr levels decreased after treatment in both groups, especially in the experimental group (p < 0.05). The stone-free rate during 1-year follow-up in the experimental group (n = 71 (97.26%)) exceeded that of the control group (n = 61 (83.56%)) (p < 0.05). CONCLUSIONS External physical vibration combined with flexible ureteroscopy lithotripsy significantly increased the rate of finding stones in the urine the day after treatment, the clearance rate of upper urinary tract calculi, and the ameliorated renal function and reduced the stone re-formation rate.
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Affiliation(s)
- Cheng Tan
- Medical Examination Centre, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang Province, China
| | - Yongbao Jiang
- Medical Examination Centre, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang Province, China
| | - Shanshan Song
- Department of Urology, Ningbo Urology and Nephrology Hospital, Ningbo University, Ningbo, Zhejiang Province, China
| | - Xiaoge Li
- Department of Urology, Ningbo Urology and Nephrology Hospital, Ningbo University, Ningbo, Zhejiang Province, China
| | - Chunliang Zhou
- Ningbo University of Finance and Economics, Ningbo, Zhejiang Province, China
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Xu ZH, Tang QL, Zhou S, Jia CP, Wang H, Lv JL. Use of extracorporeal physical vibration lithecbole through greater sciatic foramen for treatment of distal ureteral calculi. J Endourol 2021; 36:143-150. [PMID: 34098728 DOI: 10.1089/end.2021.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction To evaluate the efficacy and safety of preforming extracorporeal physical vibration lithecbole(EVPL)through greater sciatic foramen(GSF)for distal ureteral calculi(DUC) treatment. Materials and methods All patients with a diagnosis of DUC (6 - 10 mm in diameter) were enrolled in this study from October 2018 to May 2020. Patients were randomly divided into three groups receiving EPVL through GSF (Group A, n = 58), or abdominal (Group B, n = 60), or combined with oral use of tamsulosin at 0.4 mg daily (Group C, n = 63). Results There was no significant difference observed in terms of demographic characteristics or size of stones among the three groups (p >0.05). Compared with the group B and C, patients of the group A displayed a significantly higher score of comfort but with significantly decreased number of renal colic attacks or analgesics required (p < 0.01). The stone-free rate also significantly increased after one and two weeks of treatment (p < 0.01), despite such a significant difference among these groups vanished after four weeks of treatment. Conclusion Extracorporeal physical vibrational lithecbole in the prone position use the greater sciatic foramen as the path is the safe and effective approach to treat the distal ureter calculi.
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Affiliation(s)
- Zi-Hao Xu
- The Affiliated Jiangning Hospital of Nanjing Medical University, 579164, Department of Urology, Affiliated Jiangning Hospital of Nanjing Medical University, No. 168 Gushan Road, Dongshan Street, Nanjing, Nanjing, China, 211100;
| | - Qing-Lai Tang
- The Affiliated Jiangning Hospital of Nanjing Medical University, 579164, Nanjing, China;
| | - Shuang Zhou
- The Affiliated Jiangning Hospital of Nanjing Medical University, 579164, Nanjing, China;
| | - Chun-Ping Jia
- The Affiliated Jiangning Hospital of Nanjing Medical University, 579164, Nanjing, China;
| | - Hao Wang
- The Affiliated Jiangning Hospital of Nanjing Medical University, 579164, Nanjing, China;
| | - Jian-Lin Lv
- The Affiliated Jiangning Hospital of Nanjing Medical University, 579164, Nanjing, China;
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Yuan C, Jian Z, Jin X, Ma Y, Li H, Wang K. Efficacy and Safety of External Physical Vibration Lithecbole After Extracorporeal Shock Wave Lithotripsy or Retrograde Intrarenal Surgery for Urinary Stone: A Systematic Review and Meta-analysis. J Endourol 2020; 35:712-720. [PMID: 32972194 DOI: 10.1089/end.2020.0820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction: The current study evaluated the efficacy and safety of external physical vibration lithecbole (EPVL) after extracorporeal shock wave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS) for urolithiasis. Methods: Publicized literature was systematically searched from EMBASE, Cochrane Library, PubMed, ScienceDirect, ClinicalTrials.gov, and Web of Science up to February 2020. Fixed-effects or random-effects model was chosen in risk ratio (RR) calculation according to heterogeneity. Quality of evidence was estimated under the guidance of Cochrane handbook. Stone expulsion rate, stone-free rates (SFRs), and complication rates were set as end points. Results: Six randomized controlled trials, including 853 patients, were eligible for analysis. EPVL significantly increased SFR within 3 weeks (RR = 1.17, 95% CI: 1.06-1.29, P = 0.001) and above 3 weeks (RR = 1.19, 95% CI: 1.03-1.37, P = 0.02) after SWL. EPVL also improved SFR within 3 weeks (RR = 1.84, 95% CI: 1.35-2.49, P < 0.0001) and above 3 weeks (RR = 1.53, 95% CI: 1.33-1.77, P < 0.00001) after RIRS. Besides, EPVL can significantly increase SFRs for stones in renal pelvis, lower calix, and multiple locations (all P-value <0.05). Although the overall complication rate was not significantly higher in EPVL + RIRS group, it was found to be 1.38 times higher in EPVL+SWL group (RR = 1.38, 95% CI: 1.06-1.79, P = 0.02), especially the incidence of flank pain (RR = 3.11, 95% CI: 1.02-9.46, P = 0.05). Conclusions: EPVL is effective and safe with high SFRs (especially in renal pelvis, lower calix, and multiple locations) after SWL or RIRS and lower overall complication rate after RIRS in patients with urolithiasis. However, the overall complication rate (especially the incidence of flank pain) was higher after EPVL + SWL.
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Affiliation(s)
- Chi Yuan
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Zhongyu Jian
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xi Jin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yucheng Ma
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Kunjie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Peng L, Wen J, Zhong W, Zeng G. Is physical therapy effective following extracorporeal shockwave lithotripsy and retrograde intrarenal surgery: a meta-analysis and systematic review. BMC Urol 2020; 20:93. [PMID: 32646402 PMCID: PMC7350681 DOI: 10.1186/s12894-020-00664-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/30/2020] [Indexed: 12/21/2022] Open
Abstract
Background Physical therapy, including percussion, inversion, vibration and combinations, was clinically performed to improve the stone free rate (SFR) following lithotripsy procedures. However, physical therapy is not widely accepted in clinical practice owing to lack of high level evidence support and a standard protocol. The present meta-analysis aimed to evaluate the efficacy and safety of physical therapy in improving SFR following extracorporeal shockwave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS). Methods Systematic review of literature from PubMed, Scopus, Cochrane library and Embase was performed in March 2019. The efficacy and safety of physical therapy after ESWL and RIRS were assessed by meta-analysis of SFR and complication rate. Results A total of 8 prospective studies with 1065 patients were enrolled. When compared to non-intervention, physical therapy provided a higher SFR (OR:3.38, 95% CI: 2.45–4.66, p < 0.0001) at all time points (week 1, week 2 and month 1), while there was no significant difference in complications such as hematuria, lumbago, dizziness and urinary tract infection (OR: 0.84; 95%CI: 0.62–1.13; p = 0.237). In subgroup analysis of different stone locations, lower calyx stone (OR: 3.51; 95%CI: 2.21–5.55; p < 0.0001), upper ureter and renal pelvic stones (OR:2.79; 95%CI:1.62–4.81; p = 0.0002) had a higher SFR after physical therapy, while there was no significant improvement in SFR in upper and middle calyx stones. In subgroup analysis of different techniques, EPVL (external physical vibration lithecbole, OR:3.47; 95%CI:2.24–5.37; p < 0.0001) and PDI (percussion, diuresis and inversion, OR:3.24; 95%CI:2.01–5.21; p < 0.0001) were both effective in improving SFR when compared to non-intervention. Conclusions Physical therapy is effective in improving the SFR after ESWL and RIRS, especially for lower calyx stones, upper ureter and renal pelvic stones, while without significant side effects. External physical vibration lithecbole (EPVL) might provide a relative uniformed and repeatable protocol for clinical practice of physical therapy. Trial registration PROSPERO 2019 CRD42019130228.
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Affiliation(s)
- Linjie Peng
- Urology, the First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.,Guangdong Key Laboratory of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.,Guangzhou Institute of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.,Guangzhou Medical University, Guangzhou, China
| | - Junjun Wen
- Urology, the First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.,Guangdong Key Laboratory of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.,Guangzhou Institute of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.,Guangzhou Medical University, Guangzhou, China
| | - Wen Zhong
- Urology, the First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1, Haizhu District, Guangzhou, 510230, China. .,Guangdong Key Laboratory of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China. .,Guangzhou Institute of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.
| | - Guohua Zeng
- Urology, the First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1, Haizhu District, Guangzhou, 510230, China. .,Guangdong Key Laboratory of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China. .,Guangzhou Institute of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.
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Sarica K. Effective and quick discharge of residual fragments after minimal invasive stone procedures with "EPVL" modality: a new and promising approach. Urolithiasis 2020; 48:189-190. [PMID: 32239246 DOI: 10.1007/s00240-020-01184-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/17/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Kemal Sarica
- Department of Urology, Biruni University, Medical School, Medicana Bahcelievler Hospital, Istanbul, Turkey.
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