title: Diuresis and inversion therapy to improve clearance of lower caliceal stones after shock wave lithotripsy: A prospective, randomized, controlled, clinical study.
abstract: OBJECTIVE
  To improve the clearance of lower caliceal stones (LCSs) after shock wave lithotripsy (SWL) using a combination of intra-operative forced diuresis and inversion therapy.
  
  
  METHODS
  One hundred and fifty-seven consecutive patients with symptomatic, single LCSs of 5-20 mm size were prospectively randomized into two groups. The first (study group, SG) underwent SWL at the time of the maximum diuresis with the patient in the Trendelenburg position with an angle of 30 degree, while the second group (control group, CG) underwent standard SWL. After the last SWL session, patients were followed-up regularly using plain abdominal X-ray and renal ultrasound. The primary endpoint of the study was the stone-free rate (SFR) at 12 weeks.
  
  
  RESULTS
  A total of 141 patients completed the study treatment protocol and follow-up: 69 patients in SG and 72 patients in CG. Both groups were comparable in baseline data. SG showed significantly higher SFR at all follow-up time points. At week 12, 78.3% of SG were rendered stone free, whereas only 61.1% were stone free in CG (P = 0.030). Also, there was a significantly higher SFR for larger stones (>10 mm) and stones with higher attenuation value (>500 Hounsfield units) in SG than CG. Mild non-significant complications were reported in both groups.
  
  
  CONCLUSIONS
  SWL with intraoperative forced diuresis and inversion seems to be an effective measure with minimal extra cost to improve LCS clearance post-SWL.
authors: Department of Urology, Al-Azhar University, Cairo, Egypt ; Department of Urology, Salman bin Abdulaziz University, Al-kharj, Kingdom of Saudi Arabia.
authors: Abul-Fotouh
authors: AF
authors: Ahmed
authors: Department of Urology, Suez Canal University, Ismailia, Egypt ; Department of Urology, El-Iman General Hospital, Riyadh, Kingdom of Saudi Arabia.
authors: Essam
authors: E
authors: Shalaby
authors: Department of Urology, Zagazig University, Zagazig, Egypt ; Department of Urology, King Abdullah Hospital, Bisha, Kingdom of Saudi Arabia.
authors: Aref
authors: A
authors: Maarouf
authors: Department of Urology, Al-Azhar University, Cairo, Egypt.
authors: Yasser
authors: Y
authors: Badran
authors: Department of Urology, Zagazig University, Zagazig, Egypt.
authors: Mahmoud
authors: M
authors: Eladl
authors: Department of Urology, Suez Canal University, Ismailia, Egypt.
authors: Ammar
authors: A
authors: Ghobish
keywords: Extracorporeal shockwave lithotripsy; inversion therapy; outcome; renal stone; stone free