Delonca R. et al., 2022: [Evaluation of the results and feasibility of vibration, diuresis and inversion therapy in the treatment of upper urinary tract stones].

Friday, 24 March 2023

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Delonca R, Anastay V, Gondran-Tellier B, Baboudjian M, Di Crocco E, Maffei P, Thirakul S, Bienvenu L, Delaporte V, Akiki A, Gaillet S, Karsenty G, Lechevallier E, Boissier R.
Service d'urologie et de transplantation rénale, université Aix-Marseille, AP-HM, CHU Conception, Marseille, France.
Service d'urologie et de transplantation rénale, université Aix-Marseille, AP-HM, CHU Conception, Marseille, France.
Pôle de médecine physique et de la réadaptation, université Aix-Marseille, AP-HM, CHU Timone, Marseille, France.

Abstract

Objectives: To evaluate the feasibility, efficiency, and predictive factors of therapeutic success of Vibration, Diuresis and Inversion (VDI) therapy for the removal of upper urinary tract stones.

Methods: It is a retrospective, single-center study at the CHU - La Conception, Marseille, France including all patients treated with VDI from 2013 to 2018. VDI was indicated for stones <6mm in first-line treatment or for residual fragments <6mm after ureteroscopy, PCNL, microPCNL. The protocol included 4 sessions in outpatient care from 2013 to 2015 then 6 sessions from 2015 to 2018 and a final radiological evaluation.

Results: In total, 109 patients or 489 sessions are reported: median age was 55 years [14-84], median BMI 25kg/m2 [15-37], average cumulative size of kidney stones 3mm ±4. VDI was performed after flexible ureteroscopy (62%), SWL (20%), percutaneous treatment (9%) or as a first-line treatment (9%). Compliance was 87 %. The median VAS during the session was 0[0-8]. The incidence of post-session renal colic was 4% (all Clavien I). The postoperative fragment-free and microfragment rates were respectively 39% and 21%, i.e. an overall success of 60% for kidney stones, and 43% and 21%, i.e. an overall success of 64% for lower pole kidney stones.

Conclusion: VDI is a simple, non invasive and well tolerated technique for the elimination of small renal lithiasis after SWL, ureteroscopy, PCNL or as a first-line treatment.
Prog Urol. 2022 Dec 27:S1166-7087(22)00513-9. doi: 10.1016/j.purol.2022.12.005. Online ahead of print. PMID: 36581504

Comments 1

Hans-Göran Tiselius on Friday, 24 March 2023 09:30

The IBM Market Scan Commercial Database for insured patients is a national analytical tool which I only recently have been aware of. It is interesting that this national database can provide rough statistical information on diagnoses and associated treatment. In the current article the authors have looked at stone removal with URS and SWL. Valuable data were extracted, but it needs to be emphasized that in several respects this database is a black box.

Regarding the results presented in the article, size, number, location, and composition of stones are unknown. Unknown is it also if the patients had received recurrence prevention and whether the repeated treatments were carried out because of new stones, recurrent growth of residuals or even as cosmetic adjustment of asymptomatic residuals observed in follow-up imaging. Despite these reservations some important information was extracted from this analysis in 95 216 patients treated with URS and 94 523 treated with SWL. Repeat procedures per 100 patient-years were 6.8 and 4.4 for SWL and URS, respectively. It is not known how these treatment modalities were applied, but it is not impossible that those patients who primarily were treated with URS were less keen to another procedure than those primarily treated with SWL? The immediate interpretation is, however, that more patients were re-treated after SWL because of the more common presence of residual stones/fragments.
One part of the report is a multivariable analysis focused on diseases associated with increased risk of repeated treatment:

Neurogenic bladder
Paralysis
Chron’s disease
Ulcerative colitis
Diabetes mellitus
Morbid obesity
It is of note that patients with these diseases, with or without residuals after URS or SWL, need protection from recurrent stone formation or other negative development of the stone disease.

Another point that needs necessary attention is the urge to develop national databases on for instance stone disease and their treatment. Such a register, undoubtedly, would be of utmost importance, not only for analysis of the urological handling of patients with stone disease, but it also would provide essential and reasonably correct individually based economic data. Such a development step should be possible by direct and automatic extraction of un-identified data directly from patient files. The goal should be a more complete registration of important clinical details without the need of separate repeated manual registrations for straightforward scientific analyses. Why such a system has been so difficult and slow to incorporate in the health care sector is indeed surprising in year 2023!

Hans-Göran Tiselius

Regarding the results presented in the article, size, number, location, and composition of stones are unknown. Unknown is it also if the patients had received recurrence prevention and whether the repeated treatments were carried out because of new stones, recurrent growth of residuals or even as cosmetic adjustment of asymptomatic residuals observed in follow-up imaging. Despite these reservations some important information was extracted from this analysis in 95 216 patients treated with URS and 94 523 treated with SWL. Repeat procedures per 100 patient-years were 6.8 and 4.4 for SWL and URS, respectively. It is not known how these treatment modalities were applied, but it is not impossible that those patients who primarily were treated with URS were less keen to another procedure than those primarily treated with SWL? The immediate interpretation is, however, that more patients were re-treated after SWL because of the more common presence of residual stones/fragments.
One part of the report is a multivariable analysis focused on diseases associated with increased risk of repeated treatment:

Neurogenic bladder
Paralysis
Chron’s disease
Ulcerative colitis
Diabetes mellitus
Morbid obesity
It is of note that patients with these diseases, with or without residuals after URS or SWL, need protection from recurrent stone formation or other negative development of the stone disease.

Another point that needs necessary attention is the urge to develop national databases on for instance stone disease and their treatment. Such a register, undoubtedly, would be of utmost importance, not only for analysis of the urological handling of patients with stone disease, but it also would provide essential and reasonably correct individually based economic data. Such a development step should be possible by direct and automatic extraction of un-identified data directly from patient files. The goal should be a more complete registration of important clinical details without the need of separate repeated manual registrations for straightforward scientific analyses. Why such a system has been so difficult and slow to incorporate in the health care sector is indeed surprising in year 2023!

Hans-Göran Tiselius

The IBM Market Scan Commercial Database for insured patients is a national analytical tool which I only recently have been aware of. It is interesting that this national database can provide rough statistical information on diagnoses and associated treatment. In the current article the authors have looked at stone removal with URS and SWL. Valuable data were extracted, but it needs to be emphasized that in several respects this database is a black box. Regarding the results presented in the article, size, number, location, and composition of stones are unknown. Unknown is it also if the patients had received recurrence prevention and whether the repeated treatments were carried out because of new stones, recurrent growth of residuals or even as cosmetic adjustment of asymptomatic residuals observed in follow-up imaging. Despite these reservations some important information was extracted from this analysis in 95 216 patients treated with URS and 94 523 treated with SWL. Repeat procedures per 100 patient-years were 6.8 and 4.4 for SWL and URS, respectively. It is not known how these treatment modalities were applied, but it is not impossible that those patients who primarily were treated with URS were less keen to another procedure than those primarily treated with SWL? The immediate interpretation is, however, that more patients were re-treated after SWL because of the more common presence of residual stones/fragments. One part of the report is a multivariable analysis focused on diseases associated with increased risk of repeated treatment: Neurogenic bladder Paralysis Chron’s disease Ulcerative colitis Diabetes mellitus Morbid obesity It is of note that patients with these diseases, with or without residuals after URS or SWL, need protection from recurrent stone formation or other negative development of the stone disease. Another point that needs necessary attention is the urge to develop national databases on for instance stone disease and their treatment. Such a register, undoubtedly, would be of utmost importance, not only for analysis of the urological handling of patients with stone disease, but it also would provide essential and reasonably correct individually based economic data. Such a development step should be possible by direct and automatic extraction of un-identified data directly from patient files. The goal should be a more complete registration of important clinical details without the need of separate repeated manual registrations for straightforward scientific analyses. Why such a system has been so difficult and slow to incorporate in the health care sector is indeed surprising in year 2023! Hans-Göran Tiselius

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