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Ahmed AF et al, 2015: Diuresis and inversion therapy to improve clearance of lower caliceal stones after shock wave lithotripsy: A prospective, randomized, controlled, clinical study.

Ahmed AF, Shalaby E, Maarouf A, Badran Y, Eladl M, Ghobish A.
Department of Urology, Al-Azhar University, Cairo, Egypt.
Department of Urology, Salman bin Abdulaziz University, Al-kharj, Kingdom of Saudi Arabia.
Department of Urology, Suez Canal University, Ismailia, Egypt.
Department of Urology, El-Iman General Hospital, Riyadh, Kingdom of Saudi Arabia.
Department of Urology, Zagazig University, Zagazig, Egypt.
Department of Urology, King Abdullah Hospital, Bisha, Kingdom of Saudi Arabia.

Abstract

OBJECTIVE: To improve the clearance of lower caliceal stones (LCSs) after shock wave lithotripsy (SWL) using a combination of intra-operative forced diuresis and inversion therapy.
MATERIALS AND METHODS: One hundred and fifty-seven consecutive patients with symptomatic, single LCSs of 5-20 mm size were prospectively randomized into two groups. The first (study group, SG) underwent SWL at the time of the maximum diuresis with the patient in the Trendelenburg position with an angle of 30 degree, while the second group (control group, CG) underwent standard SWL. After the last SWL session, patients were followed-up regularly using plain abdominal X-ray and renal ultrasound. The primary endpoint of the study was the stone-free rate (SFR) at 12 weeks.
RESULTS: A total of 141 patients completed the study treatment protocol and follow-up: 69 patients in SG and 72 patients in CG. Both groups were comparable in baseline data. SG showed significantly higher SFR at all follow-up time points. At week 12, 78.3% of SG were rendered stone free, whereas only 61.1% were stone free in CG (P = 0.030). Also, there was a significantly higher SFR for larger stones (>10 mm) and stones with higher attenuation value (>500 Hounsfield units) in SG than CG. Mild non-significant complications were reported in both groups.
CONCLUSION: SWL with intraoperative forced diuresis and inversion seems to be an effective measure with minimal extra cost to improve LCS clearance post-SWL. 

Indian J Urol. 2015 Apr-Jun;31(2):125-31. doi: 10.4103/0970-1591.152813.

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Comments 1

Peter Alken on Wednesday, 04 November 2015 11:21

Not new but important not to forget that there is what I call ESWL plus. To those interested I also recommend the very informative paper by Lee SW et al. Comparative effectiveness and safety of various treatment procedures for lower pole renal calculi: a systematic review and network meta-analysis. BJUI. 2015; 116: 252-64.

Not new but important not to forget that there is what I call ESWL plus. To those interested I also recommend the very informative paper by Lee SW et al. Comparative effectiveness and safety of various treatment procedures for lower pole renal calculi: a systematic review and network meta-analysis. BJUI. 2015; 116: 252-64.
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