Treatment of Distal Ureteral Calculi Using Extracorporeal Physical Vibrational Lithecbole Combined with Tamsulosin: A New Option to Speed Up Obstruction Relief

Recent Advances in the Science of Burst Wave Lithotripsy and Ultrasonic Propulsion

Nephrolithiasis is a common, painful condition that requires surgery in many patients whose stones do not pass spontaneously. Recent technologic advances have enabled the use of ultrasonic propulsion to reposition stones within the urinary tract, either to relieve symptoms or facilitate treatment. Burst wave lithotripsy (BWL) has emerged as a noninvasive technique to fragment stones in awake patients without significant pain or renal injury. We review the preclinical and human studies that have explored the use of these two technologies. We envision that BWL will fill an unmet need for the noninvasive treatment of patients with nephrolithiasis.

Use of extracorporeal physical vibration lithecbole through greater sciatic foramen for treatment of distal ureteral calculi

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.

Is physical therapy effective following extracorporeal shockwave lithotripsy and retrograde intrarenal surgery: a meta-analysis and systematic review

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.

Innovations in Ultrasound Technology in the Management of Kidney Stones

This article reviews new advances in ultrasound technology for urinary stone disease. Recent research to facilitate the diagnosis of nephrolithiasis, including use of the twinkling signal and posterior acoustic shadow, have helped to improve the use of ultrasound examination for detecting and sizing renal stones. New therapeutic applications of ultrasound technology for stone disease have emerged, including ultrasonic propulsion to reposition stones and burst wave lithotripsy to fragment stones noninvasively. The safety, efficacy, and evolution of these technologies in phantom, animal, and human studies are reviewed herein. New developments in these rapidly growing areas of ultrasound research are also highlighted.