📃 Paper Title: Mechanical percussion, inversion and diuresis for residual lower pole fragments after shock wave lithotripsy: A prospective, single-blind, randomized controlled trial
🧍 Author: Kenneth T. Pace
🕒 Year: 2001
📚 Journal: The Journal of Urology
🌎 Country: Canada
ㅤContext to the study:
Can you tell me about a clinical trial that demonstrated the benefit of mechanical percussion and inversion for residual lower pole fragments after shock wave lithotripsy?
ㅤ✅ Take-home message of study:
Mechanical percussion and inversion, in combination with diuresis, are safe and effective treatment options for residual lower pole fragments following shock wave lithotripsy. This approach significantly improves the stone-free rate and reduces the stone burden, making it a promising alternative to observation alone. However, larger studies with longer follow-up are needed to confirm these findings and determine the optimal treatment duration.
ㅤ Prospective, single-blind, randomized controlled trial.
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Study participants:
Participants:
The study included 69 patients who had undergone shock wave lithotripsy and had residual lower caliceal fragments 4 mm. or less, which were randomized into two groups: mechanical percussion and inversion group (35 patients) and observation group (34 patients). The observation group then received crossover mechanical percussion and inversion if fragments persisted.
Exclusion criteria:
Patients with renal anatomical anomalies, horsehoe kidney, duplication anomaly, infundibular stenosis < 2mm, and UPJ obstruction, medical CI to inversion, including uncontrolled HTN, active CVA, morbid obesity or radiolucent stones were excluded.
Inclusion criteria:
Patients wirh residual stone fragments that were 4mm or less each in maximal size on 2 separate X ray KUBs and at least 3 months after ESWL.
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Key study outcomes:
The primary outcome measures were stone-free rate and total stone area improvement, assessed through plain film of the kidneys, ureters and bladder, renal tomography or non-contrast spiral computerized tomography. The mechanical percussion and inversion group had a substantially higher stone-free rate (40% versus 3%, respectively, p <0.001) and a greater improvement in total stone area than controls (-63.3% versus +2.7%, respectively, p <0.001).
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Study Limitations:
The study is limited by its small sample size and short follow-up period.
The study only included patients with residual lower caliceal fragments 4 mm. or less, and the results may not be generalizable to patients with larger fragments or in different locations.
The study did not measure patient satisfaction or quality of life
The study did not compare mechanical percussion and inversion with other treatment options such as ureteroscopy or repeat shock wave lithotripsy
The study did not report long-term outcomes beyond three months
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