title: Randomized controlled study of mechanical percussion, diuresis, and inversion therapy to assist passage of lower pole renal calculi after shock wave lithotripsy.
abstract: OBJECTIVE
  To determine whether mechanical percussion, diuresis, and inversion (PDI) therapy after shock wave lithotripsy (SWL) improves the clearance rates of lower pole renal stones.
  
  
  METHODS
  In this single-blind study, 108 patients who underwent SWL treatment for lower pole renal stones with a total diameter of 2 cm or less were prospectively randomized into two groups. One group (n = 49) received SWL only and the other group (n = 59) received a median of four sessions of PDI therapy (range 1 to 12), 1 to 2 weeks after each SWL session. PDI therapy was performed as follows. Patients drank 500 mL of water 30 minutes before therapy; they then lay in a prone Trendelenburg position on a 45 degrees -angle couch, and received continuous 10-minute manual mechanical percussion applied over the flank. Stone clearance was documented with plain abdominal radiography, with additional imaging, if indicated, 1 and 3 months after initial SWL therapy.
  
  
  RESULTS
  The patients from both groups were comparable in terms of total stone diameter, infundibular neck diameter, infundibular length, caliceal height, infundibular-pelvic angles, infundibular-ureteral angles, infundibular-vertebral angles, lower pole cortical thickness, and caliceal number. All patients underwent a maximum of four SWL treatments. For all assessable patients, the radiologically documented complete stone clearance rate at 3 months for the SWL-alone group was 35.4% and for the SWL plus PDI group was 62.5% (chi-square test, P = 0.006).
  
  
  CONCLUSIONS
  PDI therapy is a valuable adjunct in assisting passage of lower pole renal stone fragments after SWL therapy.
authors.affiliation: Department of Surgery, National University of Singapore, Singapore. surce@nus.edu.sg
authors.forename: Edmund
authors.initials: E
authors.lastname: Chiong
authors.forename: Sandra Tay Poh
authors.initials: ST
authors.lastname: Hwee
authors.forename: Li Man
authors.initials: LM
authors.lastname: Kay
authors.forename: Shen
authors.initials: S
authors.lastname: Liang
authors.forename: Revathi
authors.initials: R
authors.lastname: Kamaraj
authors.forename: Kesavan
authors.initials: K
authors.lastname: Esuvaranathan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004231:Diuresis; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000473:pathology / Q000628:therapy*; D007670:Kidney Calices / Q000473:pathology; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D010474:Percussion; D026741:Physical Therapy Modalities; D011187:Posture; D016037:Single-Blind Method