Zeng T. et al., 2019: Effect of mechanical percussion combined with patient position change on the elimination of upper urinary stones/fragments: a systematic review and meta-analysis

Wednesday, 20 November 2019

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Zeng T, Tiselius HG, Huang J, Deng T, Zeng G, Wu W.
Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China.
Division of Urology, Department of Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.

Abstract

The objective of this study is to explore the efficacy and safety of mechanical percussion combined with changed patient position (MPPP) on elimination of residual stones/fragments in the upper urinary tract. The study was a systematic review and meta-analysis. A systematic literature review using Pubmed, Embase, Medline, and Cochrane Library was conducted to obtain randomized-controlled trials (RCTs) evaluating the efficacy and safety of MPPP treatment of patients with residual stones/fragments in the upper urinary tract. The retrieval of data ended in October 2018. Statistical analysis was carried out using summarized unadjusted risk ratios (RRs) with 95% confidence intervals (CIs). Seven RCTs comprising 1132 patients were included. Compared with patients in the control group, patients treated with MPPP had higher stone-free rates (SFRs) with RR 1.55 (CI 1.11-2.18; p = 0.01) and lower complication rates with RR 0.48 (CI 0.25-0.94, p = 0.03). In subgroup analysis based on stone location, the SFR for the lower calyx was significantly higher in the intervention group than in the control group: RR 1.80 (CI 1.47-2.21, p < 0.00001). In subgroup analysis based on complication type, compared with the control patients, the intervention patients had lower hematuria rate with RR 0.46 (CI 0.28-0.74, p = 0.001) and lower leucocyturia rate with RR 0.33 (CI 0.12-0.89, p = 0.03). MPPP is a worthwhile non-invasive method for elimination of residual stones/fragments in the upper urinary tract. Furthermore, we recommend MPPP for patients with residual stones or fragments located in the lower calyces.

Urolithiasis. 2019 May 6. doi: 10.1007/s00240-019-01140-2. [Epub ahead of print] Review.

Comments 1

Peter Alken on Wednesday, 20 November 2019 09:28

We have to learn new abbreviations: “Mechanical percussion combined with patient position change (MPPP) includes two intervention methods: mechanical percussion, combined with diuresis and inversion therapy (PDI) or external physical vibration with the lithecbole device (EPVL).” I understand that the main difference is not with or without diuresis but with or without the treatment device used in 5 of the 7 publications evaluated. Reading all 7 articles (1-7) and also the one by Tao et al. (8) again, I find it difficult to put all publication in one analysis Wu et al. (5) treated patients after RIRS and Liu et al. (7) patients had distal ureteral stones. All results in the series of Wu et al. (6) were not significantly different. Pace et al. (1) used a mechanical chest percussor, patients in the series of Chiong et al. (2) were manually treated by a nurse. The device used by Liu et al. (7)produced vibrations with an amplitude of 4 mm, the ones used by Long et al. (4), Wu et al. (5,6) produced vibrations with an amplitude of 5 mm and the one used by Jing et al. (3) produced vibrations with amplitudes of 9 mm (Table oscillator) and 7 mm( Hand oscillator).
We looked with sonography for movements of the kidney when applying a hand held mechanical oscillator with an amplitude of 5 mm on the flank of patients in the direction of the kidney: we did not see any renal movements (unpublished data). I did not understand how sonographic targeting of stone fragments in the ureter was possible. I think the biggest effect is generated by tilting the oscillating table.

We have to learn new abbreviations: “Mechanical percussion combined with patient position change (MPPP) includes two intervention methods: mechanical percussion, combined with diuresis and inversion therapy (PDI) or external physical vibration with the lithecbole device (EPVL).” I understand that the main difference is not with or without diuresis but with or without the treatment device used  in 5 of the 7 publications evaluated. Reading all 7 articles (1-7) and also the one by Tao et al. (8) again, I find it difficult to put all publication in one analysis Wu et al. (5) treated patients after RIRS and Liu et al. (7) patients had distal ureteral stones. All results in the series of Wu et al. (6) were not significantly different. Pace et al. (1) used a mechanical chest percussor, patients in the series of Chiong et al. (2) were manually treated by a nurse. The device used by Liu et al. (7)produced vibrations with an amplitude of 4 mm, the ones used by Long et al. (4), Wu et al. (5,6)  produced vibrations with an amplitude of 5 mm  and the one used by Jing et al. (3) produced vibrations  with amplitudes of  9 mm (Table oscillator) and 7 mm( Hand oscillator).
We looked with sonography for movements of the kidney when applying a hand held mechanical oscillator with an amplitude of 5 mm on the flank of patients in the direction of the kidney: we did not see any renal movements (unpublished data). I did not understand how sonographic targeting of stone fragments in the ureter was possible. I think the biggest effect is generated by tilting the oscillating table.

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