External physical vibration lithecbole (EPVL) may be the ideal adjunct to retrograde ureteroscopic treatment of renal stones in trying to render patients free of stone fragments.
This is based on a prospective, randomized, controlled trial performed at eight different centers in China that demonstrated a 51% increase in the stone-free rate by week 5. The findings were published in the Journal of Urology (2017; 197:1289-95).
Several hundred thousand extracorporeal shock wave lithotripsy (ESWL) and ureteroscopic stone extraction procedures are performed each year in the United States. Depending upon the size, location, and composition of the original stone, residual fragments may be noted in as many as 50% of the patients and are a major risk factor for stone recurrence and stone growth. Residual stone fragments cause infection, pain, renal dysfunction, ER visits, and secondary procedures. Clearly, the removal of residual fragments is a major challenge in kidney stone management.
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In this study, Wu et al randomized 173 patients (128 men, 45 women) with residual stone fragments <4 mm in size, 1 week after ureteroscopy, including 87 patients who underwent EPVL and 86 patients who served as controls. Both groups were advised to increase their hydration and activity level, and to use inversion therapy in case of lower pole fragments.
The EPVL apparatus includes a table with a built-in oscillator (with adjustable frequency and magnitude of the vibration) that can be tilted. The second component is a handheld oscillator that can deliver multi-directional vibration of variable amplitude, frequency, and power. With the patients in supine or prone or lateral position, the fragment is repositioned with the help of multidirectional vibrations and is monitored real time with an ultrasound as it passes the ureter into the bladder. The entire procedure took about 20 minutes, and 41 patients (47%) required a second EPVL procedure if there were still some stones fragments noted by week 2.