Cakiroglu B et al, 2015: The effect of inclined position on stone free rates in patients with lower caliceal stones during SWL session.
Cakiroglu B, Sinanoglu O, Tas T, Hazar IA, Balci MB.
Hisar Intercontinental Hospital Department of Urology, Istanbul.
OBJECTIVE: To compare the outcomes of shock wave lithotripsy (SWL) combined with inclined position and SWL alone in patients with lower pole calyx stones.
METHODS: Seven hundred forty patients who underwent SWL treatment for lower pole renal stones with a total diameter of 2 cm or less were prospectively randomized into two groups. They were comparable in terms of age, sex, and stone diameters. Patients with lower calyceal stones (4-20 mm) were randomized to SWL (368 patients) or SWL with simultaneous inclination (372 patients) with 30o head down Trendelenburg position). Shock wave and session numbers were standardized according to stone size. Additional standardized shock waves were given to patients with stone fragments determined by kidney urinary bladder film and ultrasound at weeks 1, 4, 10.
RESULTS: The overall stone free rate (SFR) was 73% (268/368) in patients with SWL alone and 81% (300/372) in SWL with inclination at the end of 12th week (p = 0.015). No significant adverse events were noted in both treatment groups.
CONCLUSION: Simultaneous inclination of patients during SWL session increase SFR in lower caliceal stones significantly compared to SWL treatment alone.
Arch Ital Urol Androl. 2015 Mar 31;87(1):38-40. doi: 10.4081/aiua.2015.1.38
This is a highly interesting report with focus on one of the major problems with SWL; the difficulty to efficiently clear the lower calyx system from fragments. To find out whether SWL with inversion can improve stone-free rates, the authors randomized one of two groups to SWL in 30º Trendelenburg position. Comparison was made with a group of patients treated in standard position.
Every possibility to increase the stone-free rate during or after SWL is indeed a great achievement. It can only be speculated how effective SWL, with the patient in slight inversion position or ideally at a greater angle, might be in combination with simultaneous high diuresis. Increased clearance of fragments from the lower calyx would be one major technical solution that might deprive endoscopically oriented surgeons of their most heavy argument for judging SWL as an inferior form of stone treatment.