Does simultaneous inversion during extracorporeal shock wave lithotripsy improve stone clearance: a long-term,...

Area of Science:

• Urology
• Nephrology
• Medical Devices

Background:

• Lower pole calyx stones pose treatment challenges.
• Shock wave lithotripsy (SWL) is a common treatment for kidney stones.
• Optimizing SWL efficacy for lower pole stones is an ongoing research area.

Purpose of the Study:

• To compare the efficacy of SWL with hydration versus SWL, hydration, and inversion therapy for lower pole stones.
• To evaluate the stone-free rate (SFR) at 12 weeks post-treatment.
• To assess the long-term efficacy and safety of the combined approach.

Main Methods:

• 140 patients with lower pole stones (4-20 mm) were randomized into two groups: SWL alone or SWL with simultaneous inversion therapy (30° head-down Trendelenburg).
• Standardized shock wave treatments were administered, stratified by stone size.
• Stone clearance was assessed using radiography and ultrasound at multiple time points up to 1 year.

Main Results:

• The 12-week stone-free rate was 72% for SWL alone and 76% for SWL with inversion therapy (P = .591).
• Both groups showed a trend towards improved SFR over time, with over 80% stone-free after 1 year.
• No significant adverse effects were reported in either treatment group.

Conclusions:

• SWL with simultaneous inversion therapy is a potentially valuable adjunct for lower pole renal stones, achieving a 76% SFR.
• This combined approach may offer a 1.28 times improvement in SFR without significant additional costs.
• While not statistically significant, the results suggest a clinical benefit for incorporating inversion therapy into SWL for lower pole stones.