2022 Recommendations of the AFU Lithiasis Committee: Postural therapy.

Area of Science:

• Urology
• Nephrology
• Biomedical Engineering

Background:

• Lower calyceal stones often resist spontaneous elimination due to gravitational effects.
• Current treatment modalities may have limitations in addressing these specific stone locations.
• Postural therapy offers a non-invasive approach to enhance stone clearance.

Purpose of the Study:

• To provide the first practical recommendations for implementing postural therapy in clinical practice.
• To outline a standardized approach for utilizing postural therapy in managing lower calyceal stones.
• To address the underutilization of postural therapy despite its demonstrated benefits.

Main Methods:

• Development of recommendations using the Clinical Practice Recommendation (CPR) method.
• Adaptation of the ADAPTE method for integrating existing European Association of Urology (EAU) guidelines.
• Consideration of the French healthcare context for applicability.

Main Results:

• Postural therapy combines forced diuresis, postural inversion, and lumbar percussion.
• This procedure demonstrates a 50% improvement in fragment elimination and accelerates clearance.
• It enhances the stone-free rate for lower calyceal calculi.

Conclusions:

• Postural therapy is an effective adjunct for managing lower calyceal stones.
• Standardized recommendations are crucial to increase the adoption of this under-utilized technique.
• Further integration into urological guidelines can improve patient outcomes.