title: Mechanical percussion inversion can result in relocation of lower pole stone fragments after shock wave lithotripsy.
abstract: OBJECTIVE
  To determine whether mechanical percussion combined with inversion (MPI) therapy and forced diuresis can move stone fragments out of the lower pole of the kidney.
  
  
  METHODS
  Twelve patients with lower pole residual stone fragments at least 2 weeks after shock wave lithotripsy were treated using the following protocol. Eleven patients received 20 mg of furosemide before MPI therapy. Patients were treated in the prone Trendelenberg position on a pivoting stretcher and given 10 minutes of percussion over the flank using a mechanical chest physiotherapy percussor. Stone location was documented with plain abdominal radiographs before, immediately after, and 2 weeks following MPI therapy. Voided urine was strained immediately after MPI therapy and throughout the study period.
  
  
  RESULTS
  Abdominal radiographs before and after treatment demonstrated movement of fragments out of the lower pole in 11 patients. In 8 patients, the lower pole appeared entirely clear of fragments on the immediate post-treatment film. Four patients passed stone fragments in their first voided urine. Ten patients passed stone fragments during the 2-week follow-up period.
  
  
  CONCLUSIONS
  MPI therapy combined with diuresis can effectively mobilize stone fragments out of the lower pole calyces and appears to aid in the passage of fragments.
authors.affiliation: Division of Urology, Saint Michael's Hospital, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: R J
authors.initials: RJ
authors.lastname: D'a Honey
authors.forename: J
authors.initials: J
authors.lastname: Luymes
authors.forename: M J
authors.initials: MJ
authors.lastname: Weir
authors.forename: R
authors.initials: R
authors.lastname: Kodama
authors.forename: N
authors.initials: N
authors.lastname: Tariq
mesh_terms: D004232:Diuretics / Q000627:therapeutic use; D005665:Furosemide / Q000627:therapeutic use; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000628:therapy*; D008096:Lithotripsy; D010474:Percussion; D011187:Posture; D011859:Radiography; D016896:Treatment Outcome
chemical_list: D004232:Diuretics; D005665:Furosemide