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Jing S et al, 2018: Modified Mechanical Percussion for Upper Urinary Tract Stone Fragments after Extracorporeal Shock Wave Lithotripsy: a Prospective Multi-Center Randomized Controlled Trial.

Jing S, Liu B, Lan W, Zhao X, Bao J, Ma J, Liu Z, Liu H, Pan T, Yang J, Wu D, Zhao Y, Wang Y, Wang Z.
Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Urological Diseases, Gansu Province (Lanzhou University), Gansu Nephro-Urological Clinical Center, Lanzhou, China.
Department of Urology, Wuhan General Hospital of Guangzhou Military Region, Wuhan, China.
Department of Urology, Shenzhen People's Hospital, Second Clinical Medicine School of Jinan University, Shenzhen, China.
Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Urological Diseases, Gansu Province (Lanzhou University), Gansu Nephro-Urological Clinical Center, Lanzhou, China.

Abstract

OBJECTIVE: To investigate the effectiveness of modified mechanical percussion for eliminating upper urinary tract (UUT) stone fragments after extracorporeal shock wave lithotripsy (SWL).
MATERIALS AND METHODS: We assigned patients aged 18-60 years with UUT calculi to the modified mechanical percussion (trial) or observation (control) group. Kidney-ureter-bladder radiography and ultrasound were used for diagnostic evaluation. The primary outcome was the stone-expulsion rate (SER) at 6 hours. The first stone-expulsion time, the SER at 3, 12, and 24 hours, the stone-free rate (SFR), additional interventions, and adverse events (AEs) were recorded.
RESULTS: A total of 120 patients underwent randomization: 60 for each group. The mean first stone-expulsion time in the trial and control groups was 6.75 and 13.58 hours, respectively (p=0.001). The SERs at 3, 6, and 12 hours in the trial group were 51.8%, 75.4%, and 76.8%, respectively, which were higher than the control group (all p<0. 05). Among patients expelled fragments within 6 hours, the SFRs were improved at 1 week (p=0.002) and at 2 weeks (p=0.000). Patients needed fewer additional interventions in the trial group (p=0.035). AEs occurred in 42.9% (24/56) and 67.9% (38/56) of the patients in the trial and control groups, respectively (p=0.008). Age, gender, stone size and location, and SER at 24 hours did not differ significantly among the groups.
CONCLUSIONS: Modified mechanical percussion significantly improved SERs and accelerated stone passage after SWL, resulting in a stone-free status with a lower risk of AEs and reduced need for additional interventions.

Urology. 2018 Mar 12. pii: S0090-4295(17)31352-3. doi: 10.1016/j.urology.2017.12.024. [Epub ahead of print]

 

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Comments 1

Peter Alken on Monday, 23 July 2018 08:51

This adds to the positive results with post-ESWL percussion-inversion-diuresis protocols. The results are surprisingly good from the very start: Failure to break the stone was not an exclusion criterion. All 120 stones were fragmented. “All patients were subjected to SWL once, and the SWL parameters were similar between the two groups; the SWL shock wave frequency was 1.0-1.5 Hz, the treatment voltage was 20-24 kV, and the duration was 15-30 minutes.” This in itself is a record-breaking result. 90 ureteral stones and 30 renal stones is a rather selective distribution. Statistics on small numbers like the treatment of a few kidney stones (1upper pole, 6 mid region, 2 lower pole, 3 pelvic) may be misleading. I think that the possibility to tilt the table in the horizontal and in the lateral direction has a decisive influence on the observed effects.
Duplication of the results in other hands is important.

This adds to the positive results with post-ESWL percussion-inversion-diuresis protocols. The results are surprisingly good from the very start: Failure to break the stone was not an exclusion criterion. All 120 stones were fragmented. “All patients were subjected to SWL once, and the SWL parameters were similar between the two groups; the SWL shock wave frequency was 1.0-1.5 Hz, the treatment voltage was 20-24 kV, and the duration was 15-30 minutes.” This in itself is a record-breaking result. 90 ureteral stones and 30 renal stones is a rather selective distribution. Statistics on small numbers like the treatment of a few kidney stones (1upper pole, 6 mid region, 2 lower pole, 3 pelvic) may be misleading. I think that the possibility to tilt the table in the horizontal and in the lateral direction has a decisive influence on the observed effects. Duplication of the results in other hands is important.
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