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Peng L. et al., 2020: Is physical therapy effective following extracorporeal shockwave lithotripsy and retrograde intrarenal surgery: a meta-analysis and systematic review

Peng L, Wen J, Zhong W, Zeng G.
Urology, the First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.
Guangdong Key Laboratory of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.
Guangzhou Institute of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.
Guangzhou Medical University, Guangzhou, China.
Urology, the First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.
Guangdong Key Laboratory of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.
Guangzhou Institute of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.
Urology, the First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.
Guangdong Key Laboratory of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.
Guangzhou Institute of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China. 

Abstract

Background: Physical therapy, including percussion, inversion, vibration and combinations, was clinically performed to improve the stone free rate (SFR) following lithotripsy procedures. However, physical therapy is not widely accepted in clinical practice owing to lack of high level evidence support and a standard protocol. The present meta-analysis aimed to evaluate the efficacy and safety of physical therapy in improving SFR following extracorporeal shockwave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS).

Methods: Systematic review of literature from PubMed, Scopus, Cochrane library and Embase was performed in March 2019. The efficacy and safety of physical therapy after ESWL and RIRS were assessed by meta-analysis of SFR and complication rate.

Results: A total of 8 prospective studies with 1065 patients were enrolled. When compared to non-intervention, physical therapy provided a higher SFR (OR:3.38, 95% CI: 2.45-4.66, p < 0.0001) at all time points (week 1, week 2 and month 1), while there was no significant difference in complications such as hematuria, lumbago, dizziness and urinary tract infection (OR: 0.84; 95%CI: 0.62-1.13; p = 0.237). In subgroup analysis of different stone locations, lower calyx stone (OR: 3.51; 95%CI: 2.21-5.55; p < 0.0001), upper ureter and renal pelvic stones (OR:2.79; 95%CI:1.62-4.81; p = 0.0002) had a higher SFR after physical therapy, while there was no significant improvement in SFR in upper and middle calyx stones. In subgroup analysis of different techniques, EPVL (external physical vibration lithecbole, OR:3.47; 95%CI:2.24-5.37; p < 0.0001) and PDI (percussion, diuresis and inversion, OR:3.24; 95%CI:2.01-5.21; p < 0.0001) were both effective in improving SFR when compared to non-intervention.

Conclusions: Physical therapy is effective in improving the SFR after ESWL and RIRS, especially for lower calyx stones, upper ureter and renal pelvic stones, while without significant side effects. External physical vibration lithecbole (EPVL) might provide a relative uniformed and repeatable protocol for clinical practice of physical therapy.
BMC Urol. 2020 Jul 9;20(1):93. doi: 10.1186/s12894-020-00664-9. PMID: 32646402. FREE ARTICLE

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Commentaires 1

Peter Alken le vendredi 29 janvier 2021 09:16

I am not aware of a country where the facilitation of stone fragment discharge by physical means after stone therapy gets more attention by Urologists than China - at least publication wise.
Percussion, diuresis, and inversion (PDI), mechanical percussion combined with patient position change (MPPP) or external physical vibration with the lithecbole device (EPVL) are describing similar principles using different equipment.

The Chinese series includes a review on all available intra- and postoperative techniques to prevent or remove residual fragments (1). It culminated with the present meta-analysis published in 2020 (2) and 2 similar meta-analyses also published this year (3,4).
It started with an unusual Cochrane review in 2013 (5) on two PDI papers (6,7); unusual as there were only two publications on the topic until that time for a review.
Since then and after two publications in Chinese journals (8,9) referred to by Zhang et al. (10), there are 7 publications (10-16).Six of them (10-12,14-16) are preferably authored by a group that developed an equipment, the EPVL (Friend-I type, Zhengzhou Kang Bai Jia Medical Instrument Co., Ltd., China).
It looks a little bit like a joint Chinese effort to push the EPVL into the market.
The techniques differ and there is no consent on the degree of table reclinement with the angle of inversion varying from 12° to >70° (6, 7, 17-19).
In real western life, it will not be the cost of the machine but of the physiotherapists that may hamper a wide spread use.
I gave my patients two simple drawings (Fig. 1) to explain to them how they could promote fragment passage and recommended to lay - when resting - on the side opposite to the SWL side.

https://www.storzmedical.com/images/blog/Peng.JPG

1 Jing S, Gai Q, Zhao X, Wang J, Gong Y, Pang Y, Peng C, Tian Y, Wang Y, Wang Z.. Physical therapy in the management of stone fragments: progress, status, and needs. Urolithiasis. 2018;46(3):223 9.

2 Peng L, Wen J, Zhong W, Zeng G. Is physical therapy effective following extracorporeal shockwave lithotripsy and retrograde intrarenal surgery: a meta-analysis and systematic review. BMC Urol. 2020 Jul 9;20(1):93. doi: 10.1186/s12894-020-00664-9.PMID: 32646402
Free PMC article

3 Zeng T, Tiselius HG, Huang J, Deng T, Zeng G, Wu W. Effect of mechanical percussion combined with patient position change on the elimination of upper urinary stones/fragments: a systematic review and meta-analysis. Urolithiasis. 2020 Apr;48(2):95-102. doi: 10.1007/s00240-019-01140-2.

4 Yuan C, Jian Z, Jin X, Ma YC, Li H, Wang KJ. Efficacy and safety of external physical vibration lithecbole (EPVL) after extracorporeal shock wave lithotripsy (ESWL) or retrograde intrarenal surgery (RIRS) for urinary stone: A systematic review and meta-analysis. J Endourol. 2020 Sep 24. doi: 10.1089/end.2020.0820.

5 Liu LR, Li QJ, Wei Q, Liu ZH, Xu Y. Percussion, diuresis, and inversion therapy for the passage of lower pole kidney stones following shock wave lithotripsy. Cochrane Database Syst Rev. 2013 Dec 8;(12):CD008569. doi: 10.1002/14651858.CD008569.

6 Pace KT, Tariq N, Dyer SJ, Weir MJ, D'A Honey RJ. Mechanical percussion, inversion and diuresis for residual lower pole fragments after shock wave lithotripsy: a prospective, single blind, randomized controlled trial. J Urol. 2001 Dec;166(6):2065-71.

7 Chiong E, Hwee ST, Kay LM, Liang S, Kamaraj R, Esuvaranathan K. Randomized controlled study of mechanical percussion, diuresis, and inversion therapy to assist passage of lower pole renal calculi after shock wave lithotripsy. Urology. 2005 Jun;65(6):1070-4. doi: 10.1016/j.urology.2004.12.045.

8 Xu C, Wang Y, Chu X et al (2013) Clinical application of physical vibration lithecbole in upper urinary calculi after extracorporeal shock-wave lithotripsy. Chin J Urol 34(8):599–602

9 Zhang R, Qin X, Liu Z, Tang L, Zou Z, Liang J, Wang Y, Tang Y, Lu Y (2016) The efficacy of external physical vibration lithecbole in the assistant treatment of the upper urinary tract residual stones: a meta-analysis. Zhonghua Yi Xue Za Zhi 96(38):3094–3098


10 Zhang Y, Xu C, Wang Y, Wang R, Wu W, Yan J, Gu X, Chen X, Wang X, Ye Z, Zeng G. When is the best time to perform external physical vibration lithecbole (EPVL) after retrograde intrarenal surgery (RIRS): a multicenter study based on randomized controlled trials. Urolithiasis. 2019. Dec 16. doi: 10.1007/s00240-019-01175-5.)

11 Long Q, Zhang J, Xu Z, Zhu Y, Liu L, Wang H, Guo J, Wang G. A Prospective Randomized Controlled Trial of the Efficacy of External Physical Vibration Lithecbole after Extracorporeal Shock Wave Lithotripsy for a Lower Pole Renal Stone Less Than 2 cm. J. Urol. 195 (2016)195 965-970

12 Wu W, Yang Z, Xu C, Gu X, Yang S, Liao S, Wang R, Gao W, Ye Z, Zeng G. External Physical Vibration Lithecbole Promotes the Clearance of Upper Urinary Stones after Retrograde Intrarenal Surgery: A Prospective, Multicenter, Randomized Controlled Trial. J Urol. 197 (2017):1289-1295. doi: 10.1016/j.juro.2017.01.001.

13 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. Modified Mechanical Percussion for Upper Urinary Tract Stone Fragments After Extracorporeal Shock Wave Lithotripsy: A Prospective Multicenter Randomized Controlled Trial. Urology. 116 (2018) 47-54. doi: 10.1016/j.urology.2017.12.024


14 Liu G, Cheng Y, Wu W, Jia X, Hu J, Xie G, Chen X. Treatment of Distal Ureteral Calculi Using Extracorporeal Physical Vibrational Lithecbole Combined with Tamsulosin: A New Option to Speed Up Obstruction Relief. J Endourol. 32 (2018) 161-167. doi: 10.1089/end.2017.0560.

15 Wu W, Yang Z, Tang F, Xu C, Wang Y, Gu X, Chen X, Wang R, Yan J, Wang X, Gao W, Hou C, Guo J, Zhang J, Gurioli A, Ye Z, Zeng G.
How to accelerate the upper urinary stone discharge after extracorporeal shockwave lithotripsy (ESWL) for

I am not aware of a country where the facilitation of stone fragment discharge by physical means after stone therapy gets more attention by Urologists than China - at least publication wise. Percussion, diuresis, and inversion (PDI), mechanical percussion combined with patient position change (MPPP) or external physical vibration with the lithecbole device (EPVL) are describing similar principles using different equipment. The Chinese series includes a review on all available intra- and postoperative techniques to prevent or remove residual fragments (1). It culminated with the present meta-analysis published in 2020 (2) and 2 similar meta-analyses also published this year (3,4). It started with an unusual Cochrane review in 2013 (5) on two PDI papers (6,7); unusual as there were only two publications on the topic until that time for a review. Since then and after two publications in Chinese journals (8,9) referred to by Zhang et al. (10), there are 7 publications (10-16).Six of them (10-12,14-16) are preferably authored by a group that developed an equipment, the EPVL (Friend-I type, Zhengzhou Kang Bai Jia Medical Instrument Co., Ltd., China). It looks a little bit like a joint Chinese effort to push the EPVL into the market. The techniques differ and there is no consent on the degree of table reclinement with the angle of inversion varying from 12° to >70° (6, 7, 17-19). In real western life, it will not be the cost of the machine but of the physiotherapists that may hamper a wide spread use. I gave my patients two simple drawings (Fig. 1) to explain to them how they could promote fragment passage and recommended to lay - when resting - on the side opposite to the SWL side. [img]https://www.storzmedical.com/images/blog/Peng.JPG[/img] 1 Jing S, Gai Q, Zhao X, Wang J, Gong Y, Pang Y, Peng C, Tian Y, Wang Y, Wang Z.. Physical therapy in the management of stone fragments: progress, status, and needs. Urolithiasis. 2018;46(3):223 9. 2 Peng L, Wen J, Zhong W, Zeng G. Is physical therapy effective following extracorporeal shockwave lithotripsy and retrograde intrarenal surgery: a meta-analysis and systematic review. BMC Urol. 2020 Jul 9;20(1):93. doi: 10.1186/s12894-020-00664-9.PMID: 32646402 Free PMC article 3 Zeng T, Tiselius HG, Huang J, Deng T, Zeng G, Wu W. Effect of mechanical percussion combined with patient position change on the elimination of upper urinary stones/fragments: a systematic review and meta-analysis. Urolithiasis. 2020 Apr;48(2):95-102. doi: 10.1007/s00240-019-01140-2. 4 Yuan C, Jian Z, Jin X, Ma YC, Li H, Wang KJ. Efficacy and safety of external physical vibration lithecbole (EPVL) after extracorporeal shock wave lithotripsy (ESWL) or retrograde intrarenal surgery (RIRS) for urinary stone: A systematic review and meta-analysis. J Endourol. 2020 Sep 24. doi: 10.1089/end.2020.0820. 5 Liu LR, Li QJ, Wei Q, Liu ZH, Xu Y. Percussion, diuresis, and inversion therapy for the passage of lower pole kidney stones following shock wave lithotripsy. Cochrane Database Syst Rev. 2013 Dec 8;(12):CD008569. doi: 10.1002/14651858.CD008569. 6 Pace KT, Tariq N, Dyer SJ, Weir MJ, D'A Honey RJ. Mechanical percussion, inversion and diuresis for residual lower pole fragments after shock wave lithotripsy: a prospective, single blind, randomized controlled trial. J Urol. 2001 Dec;166(6):2065-71. 7 Chiong E, Hwee ST, Kay LM, Liang S, Kamaraj R, Esuvaranathan K. Randomized controlled study of mechanical percussion, diuresis, and inversion therapy to assist passage of lower pole renal calculi after shock wave lithotripsy. Urology. 2005 Jun;65(6):1070-4. doi: 10.1016/j.urology.2004.12.045. 8 Xu C, Wang Y, Chu X et al (2013) Clinical application of physical vibration lithecbole in upper urinary calculi after extracorporeal shock-wave lithotripsy. Chin J Urol 34(8):599–602 9 Zhang R, Qin X, Liu Z, Tang L, Zou Z, Liang J, Wang Y, Tang Y, Lu Y (2016) The efficacy of external physical vibration lithecbole in the assistant treatment of the upper urinary tract residual stones: a meta-analysis. Zhonghua Yi Xue Za Zhi 96(38):3094–3098 10 Zhang Y, Xu C, Wang Y, Wang R, Wu W, Yan J, Gu X, Chen X, Wang X, Ye Z, Zeng G. When is the best time to perform external physical vibration lithecbole (EPVL) after retrograde intrarenal surgery (RIRS): a multicenter study based on randomized controlled trials. Urolithiasis. 2019. Dec 16. doi: 10.1007/s00240-019-01175-5.) 11 Long Q, Zhang J, Xu Z, Zhu Y, Liu L, Wang H, Guo J, Wang G. A Prospective Randomized Controlled Trial of the Efficacy of External Physical Vibration Lithecbole after Extracorporeal Shock Wave Lithotripsy for a Lower Pole Renal Stone Less Than 2 cm. J. Urol. 195 (2016)195 965-970 12 Wu W, Yang Z, Xu C, Gu X, Yang S, Liao S, Wang R, Gao W, Ye Z, Zeng G. External Physical Vibration Lithecbole Promotes the Clearance of Upper Urinary Stones after Retrograde Intrarenal Surgery: A Prospective, Multicenter, Randomized Controlled Trial. J Urol. 197 (2017):1289-1295. doi: 10.1016/j.juro.2017.01.001. 13 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. Modified Mechanical Percussion for Upper Urinary Tract Stone Fragments After Extracorporeal Shock Wave Lithotripsy: A Prospective Multicenter Randomized Controlled Trial. Urology. 116 (2018) 47-54. doi: 10.1016/j.urology.2017.12.024 14 Liu G, Cheng Y, Wu W, Jia X, Hu J, Xie G, Chen X. Treatment of Distal Ureteral Calculi Using Extracorporeal Physical Vibrational Lithecbole Combined with Tamsulosin: A New Option to Speed Up Obstruction Relief. J Endourol. 32 (2018) 161-167. doi: 10.1089/end.2017.0560. 15 Wu W, Yang Z, Tang F, Xu C, Wang Y, Gu X, Chen X, Wang R, Yan J, Wang X, Gao W, Hou C, Guo J, Zhang J, Gurioli A, Ye Z, Zeng G. How to accelerate the upper urinary stone discharge after extracorporeal shockwave lithotripsy (ESWL) for
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