Scolaris Content Display Scolaris Content Display

Percussion, diuresis, and inversion therapy for the passage of lower pole kidney stones following shock wave lithotripsy

Collapse all Expand all

References

References to studies included in this review

Chiong 2005 {published data only}

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;65(6):1070‐4. [MEDLINE: 15922429]

Pace 2001 {published data only}

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. Journal of Urology 2001;166(6):2065‐71. [MEDLINE: 11696708]

References to studies excluded from this review

Albanis 2009 {published data only}

Albanis S, Ather HM, Papatsoris AG, Masood J, Staios D, Sheikh T, et al. Inversion, hydration and diuresis during extracorporeal shock wave lithotripsy: does it improve the stone‐free rate for lower pole stone clearance?. Urologia Internationalis 2009;83(2):211‐6. [MEDLINE: 19752619]

Arrabal‐Martin 2006 {published data only}

Arrabal‐Martin M, Fernandez‐Rodriguez A, Arrabal‐Polo MA, Garcia‐Ruiz MJ, Zuluaga‐Gomez A. Extracorporeal renal lithotripsy: evolution of residual lithiasis treated with thiazides. Urology 2006;68(5):956‐9. [MEDLINE: 17113886]

Azm 2002 {published data only}

Azm TA, Higazy H. Effect of diuresis on extracorporeal shockwave lithotripsy treatment of ureteric calculi. Scandinavian Journal of Urology & Nephrology 2002;36(3):209‐12. [MEDLINE: 12201937]

De Sio 2008 {published data only}

Danuser H. Editorial comment on: modified supine versus prone position in percutaneous nephrolithotomy for renal stones treatable with a single percutaneous access: a prospective randomized trial. European Urology 2008;54(1):203. [MEDLINE: 18262720]
De Sio M, Autorino R, Quarto G, Calabro F, Damiano R, Giugliano F, et al. Modified supine versus prone position in percutaneous nephrolithotomy for renal stones treatable with a single percutaneous access: a prospective randomized trial. European Urology 2008;54(1):196‐202. [MEDLINE: 18262711]

Falahatkar 2008 {published data only}

Falahatkar S, Moghaddam AA, Salehi M, Nikpour S, Esmaili F, Khaki N. Complete supine percutaneous nephrolithotripsy comparison with the prone standard technique. Journal of Endourology 2008;22(11):2513‐7. [MEDLINE: 19046091]

Goktas 2000 {published data only}

Goktas S, Peskircioglu L, Tahmaz L, Kibar Y, Erduran D, Harmankaya C. Is there significance of the choice of prone versus supine position in the treatment of proximal ureter stones with extracorporeal shock wave lithotripsy?. European Urology 2000;38(5):618‐20. [MEDLINE: 11096246]

Ulmann 1984 {published data only}

Ulmann A, Sayegh F, Clavel J, Lacour B. Incidence of lithiasic recurrence after a diuretic therapy, alone or combined with treatment by a thiazide diuretic or phosphorus [Frequence des recidives lithiasiques apres une cure de diurese simple ou associee a un traitement par un diuretique thiazidique ou le phosphore]. Presse Medicale 1984;13(20):1257‐60. [MEDLINE: 6232583]

Zomorrodi 2008 {published data only}

Zomorrodi A, Golivandan J, Samady J. Effect of diuretics on ureteral stone therapy with extracorporeal shock wave lithotripsy. Saudi Journal of Kidney Diseases & Transplantation 2008;19(3):397‐400. [MEDLINE: 18445899]

Brownlee 1990

Brownlee N, Foster M, Griffith DP, Carlton CE. Controlled inversion therapy: an adjunct to the elimination of gravity‐dependent fragments following extracorporeal shock wave lithotripsy. Journal of Urology 1990;143(6):1096‐8. [MEDLINE: 2342166]

Cass 1998

Cass AS, Grine WB, Jenkins JM, Jordan WR, Mobley TB, Myers DA. The incidence of lower‐pole nephrolithiasis‐‐increasing or not?. British Journal of Urology 1998;82(1):12‐5. [MEDLINE: 9698656]

Higgins 2003

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. [MEDLINE: 12958120]

Higgins 2011

Higgins JP, Green S (Editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.

Honey 2008

Honey J. Treating lower pole renal stones: in defence of shock wave lithotripsy. Canadian Urological Association Journal 2008;2(6):625‐7. [PUBMED: 19066683]

Kekre 2008

Kekre NS, Kumar S. Optimizing the fragmentation and clearance after shock wave lithotripsy. Current Opinion in Urology 2008;18(2):205‐9. [MEDLINE: 18303545]

Lin 2008

Lin CC, Hsu YS, Chen KK. Predictive factors of lower calyceal stone clearance after extracorporeal shockwave lithotripsy (ESWL): the impact of radiological anatomy. Journal of the Chinese Medical Association 2008;71(10):496‐501. [MEDLINE: 18955183]

Lingeman 1994

Lingeman JE, Siegel YI, Steele B, Nyhuis AW, Woods JR. Management of lower pole nephrolithiasis: a critical analysis. Journal of Urology 1994;151(3):663‐7. [MEDLINE: 8308977]

McCullough 1989

McCullough DL. Extracorporeal shock wave lithotripsy and residual stone fragments in lower calices. Journal of Urology 1989;141(1):140. [MEDLINE: 2908940]

Murphy 2001

Murphy DP, Streem SB. Lower pole renal calculi: when and how to treat. Brazilian Journal of Urology 2001;27(1):3‐9. [EMBASE: 2001135695]

Nuss 2005

Nuss GR, Rackley JD, Assimos DG. Adjunctive therapy to promote stone passage. Reviews in Urology 2005;7(2):67‐74. [PUBMED: 16985812]

Poch 2009

Poch M, Haleblian GE. Minimally invasive stone surgery: percutaneous, ureteroscopic and extracorporeal approaches to renal and ureteral calculi. Medicine & Health, Rhode Island 2009;92(10):339‐41. [MEDLINE: 19911714]

Raman 2008

Raman JD, Pearle MS. Management options for lower pole renal calculi. Current Opinion in Urology 2008;18(2):214‐9. [MEDLINE: 18303547]

Rodrigues 1991

Rodrigues Netto N, Claro JF, Cortado PL, Lemos GC. Adjunct controlled inversion therapy following extracorporeal shock wave lithotripsy for lower pole caliceal stones. Journal of Urology 1991;146(4):953‐4. [MEDLINE: 1895449]

Srisubat 2009

Srisubat A, Potisat S, Lojanapiwat B, Setthawong V, Laopaiboon M. Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database of Systematic Reviews 2009, Issue 4. [DOI: 10.1002/14651858.CD007044.pub2]

References to other published versions of this review

Liu 2010

Liu LR, Li QJ, Wei Q, Liu ZH, Xu Y. Percussion, diuresis and inversion therapy for the passage of lower pole kidney stones after shock wave lithotripsy. Cochrane Database of Systematic Reviews 2010, Issue 7. [DOI: 10.1002/14651858.CD008569]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Jump to:

Chiong 2005

Methods

  • Study design: single‐blind, prospective RCT

  • Study duration: study commenced in 2001

Participants

  • Country: Singapore

  • Setting: single centre

  • Aged 18 years or over with lower pole kidney stones between 0.4 cm to 2 cm diameter at 3 months after shock wave lithotripsy treatment

  • Number: treatment group (59); control group (49)

  • Mean age; range (years): treatment group (49; 21 to 71); control group (45; 23 to 72)

  • Sex (M/F): treatment group (50/9); control group (30/19)

  • Initial stone size; range: treatment group (0.8 mm; 0.4 mm to 2 mm); control group 1.0 mm (0.4 mm to 2 mm)

  • Exclusion criteria: collecting system abnormalities; patients with ureteral stents in situ; history of cardiac, renal, or respiratory failure; history of complications from previous SWL; gastroesophageal reflux disease

Interventions

Treatment group

  • Median of four sessions of percussion, diuresis, and inversion therapy between 1 and 2 weeks after each SWL session

  • Additional percussion, diuresis, inversion therapy provided with documented radiologic residual stone fragments at 1 month or after additional SWL within the 3 month study period

  • Percussion, diuresis, and inversion therapy involved:

    • drinking 500 mL of water 30 min before therapy

    • positioning in a prone Trendelenburg position on a 45º angle

    • continuous 10 min manual mechanical percussion over the flank/session

Control group

  • SWL only

Outcomes

  • Stone‐free rate

  • Stone burden reduction

  • Complications

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

"Using simple randomization by computer"

Allocation concealment (selection bias)

Unclear risk

"Patients were randomized to a control group or SWL plus percussion, diuresis, inversion therapy group using simple randomization by computer"

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Blinded to the radiologist only

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Blinded to the radiologist only

Incomplete outcome data (attrition bias)
All outcomes

Low risk

ITT analysis reported. 2.7% of randomised patients were lost to follow‐up, however data for all patients were reported

Selective reporting (reporting bias)

Low risk

Stone‐free rate and the overall reduction in stone size had been reported. Study protocol was not available

Other bias

Low risk

Supported by a National Healthcare Group research grant (Singapore)

Pace 2001

Methods

  • Study design: prospective, single blind, cross‐over RCT

  • Study duration: January 1999 to June 2000

Participants

  • Country: Canada

  • Setting: single centre

  • All participants aged ≥ 18 years with lower pole kidney stones 4 mm or less at 3 months after SWL

  • Number: treatment group (35); control group (34)

  • Mean age ± SD (years): treatment group (52.0 ± 11.6); control group (40.6 ± 22.)

  • Sex (M/F): treatment group (23/12); control group (29/5)

  • Initial stone area ± SD: treatment group (61.7 ± 60.2 mm²); control group (70.9 ± 87.2 mm²)

  • Exclusion criteria: anatomical anomalies, such as horseshoe kidney, fragments in a caliceal diverticulum, infundibular stenosis less than 2 mm on compression film of IVP; radiolucent calculi, furosemide allergy; medical conditions that might make inversion dangerous

Interventions

Treatment group

  • Received 20 mg furosemide followed by inversion to at least 60° and 10 minutes of flank percussion with a mechanical chest percussor weekly for 3 weeks or until stone‐free

Control group

  • Observation for 4 weeks. Patients were offered opportunity to cross‐over to receive mechanical percussion and inversion following observation

Outcomes

  • Success: stone‐free rate

  • Effectiveness: stone burden reduction rate

  • Complications

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Patients were randomised with simple block randomisation

Allocation concealment (selection bias)

Unclear risk

Patients were randomised with simple block randomisation to treatment group or observation group.

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Blinded to the radiologist only

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

"A blinded radiologist adjudicated all films to determine final stone free state"

Incomplete outcome data (attrition bias)
All outcomes

Low risk

ITT analysis reported, 11.5% of randomised patients were lost to follow‐up, however data for all patients has been reported

Selective reporting (reporting bias)

Low risk

Primary outcomes (stone free rate and stone burden reduction rate) were reported. Study protocol was available

Other bias

Unclear risk

Source of funding not stated

ITT, intention‐to‐treat; IVP, intravenous pyelogram; RCT, randomised controlled trial; SWL, shock wave lithotripsy

Characteristics of excluded studies [ordered by study ID]

Jump to:

Study

Reason for exclusion

Albanis 2009

Not RCT

Arrabal‐Martin 2006

Did not assess percussion, diuresis, and inversion therapy for passage of lower pole kidney stones

Azm 2002

Did not assess percussion, diuresis, and inversion therapy for passage of lower pole kidney stones

De Sio 2008

Did not assess percussion, diuresis, and inversion therapy for passage of lower pole kidney stones

Falahatkar 2008

Did not assess percussion, diuresis, and inversion therapy for passage of lower pole kidney stones

Goktas 2000

Did not assess percussion, diuresis, and inversion therapy for passage of lower pole kidney stones

Ulmann 1984

Did not assess percussion, diuresis, and inversion therapy for passage of lower pole kidney stones

Zomorrodi 2008

Did not assess percussion, diuresis and inversion therapy for passage of lower pole kidney stones

RCT, randomised controlled trial

Data and analyses

Open in table viewer
Comparison 1. Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Stone‐free rate Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 1.1

Comparison 1 Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy, Outcome 1 Stone‐free rate.

Comparison 1 Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy, Outcome 1 Stone‐free rate.

2 Stone burden reduction Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 1.2

Comparison 1 Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy, Outcome 2 Stone burden reduction.

Comparison 1 Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy, Outcome 2 Stone burden reduction.

3 Complications Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 1.3

Comparison 1 Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy, Outcome 3 Complications.

Comparison 1 Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy, Outcome 3 Complications.

Open in table viewer
Comparison 2. Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Stone‐free rate Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 2.1

Comparison 2 Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone, Outcome 1 Stone‐free rate.

Comparison 2 Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone, Outcome 1 Stone‐free rate.

2 Stone burden reduction Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 2.2

Comparison 2 Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone, Outcome 2 Stone burden reduction.

Comparison 2 Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone, Outcome 2 Stone burden reduction.

3 Complications Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 2.3

Comparison 2 Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone, Outcome 3 Complications.

Comparison 2 Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone, Outcome 3 Complications.

Study flow diagram
Figures and Tables -
Figure 1

Study flow diagram

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy, Outcome 1 Stone‐free rate.
Figures and Tables -
Analysis 1.1

Comparison 1 Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy, Outcome 1 Stone‐free rate.

Comparison 1 Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy, Outcome 2 Stone burden reduction.
Figures and Tables -
Analysis 1.2

Comparison 1 Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy, Outcome 2 Stone burden reduction.

Comparison 1 Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy, Outcome 3 Complications.
Figures and Tables -
Analysis 1.3

Comparison 1 Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy, Outcome 3 Complications.

Comparison 2 Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone, Outcome 1 Stone‐free rate.
Figures and Tables -
Analysis 2.1

Comparison 2 Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone, Outcome 1 Stone‐free rate.

Comparison 2 Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone, Outcome 2 Stone burden reduction.
Figures and Tables -
Analysis 2.2

Comparison 2 Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone, Outcome 2 Stone burden reduction.

Comparison 2 Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone, Outcome 3 Complications.
Figures and Tables -
Analysis 2.3

Comparison 2 Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone, Outcome 3 Complications.

Comparison 1. Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Stone‐free rate Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Stone burden reduction Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

3 Complications Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figures and Tables -
Comparison 1. Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy
Comparison 2. Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Stone‐free rate Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Stone burden reduction Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

3 Complications Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figures and Tables -
Comparison 2. Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone