Is physical therapy effective following extracorporeal shockwave lithotripsy and retrograde intrarenal surgery: a meta-analysis and systematic review

Abstract

Objective: Physical therapy, including percussion, inversion, vibration and combinations, was clinically performed to improve the stone free rate (SFR) following lithotripsy procedures. However, physical therapy is not widely accepted in clinical practice owing to lack of high level evidence support and a standard protocol. The present meta-analysis aimed to evaluate the efficacy and safety of physical therapy in improving SFR following extracorporeal shockwave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS).Methods: Systematic review of literature from PubMed, Scopus, Cochrane library and Embase was performed in March 2019. The efficacy and safety of physical therapy after ESWL and RIRS were assessed by meta-analysis of SFR and complication rate.Results: A total of 8 prospective studies with 1065 patients were enrolled. When compared to non-intervention, physical therapy provided a higher SFR (OR:3.38, 95% CI: 2.45-4.66, p< 0.0001) at all time points (week 1, week 2 and month 1), while there was no significant difference in complications such as hematuria, lumbago, dizziness and urinary tract infection(OR: 0.84; 95%CI: 0.62-1.13; p=0.237). In subgroup analysis of different stone locations, lower calyx stone (OR: 3.51; 95%CI: 2.21-5.55; p<0.0001), upper ureter and renal pelvic stones (OR:2.79; 95%CI:1.62-4.81; p=0.0002) had a higher SFR after physical therapy, while there was no significant improvement in SFR in upper and middle calyx stones. In subgroup analysis of different techniques, EPVL (external physical vibration lithecbole, OR:3.47; 95%CI:2.24-5.37; p<0.0001) and PDI (percussion, diuresis and inversion, OR:3.24; 95%CI:2.01-5.21; p<0.0001) were both effective in improving SFR when compared to non-intervention. Conclusions: Physical therapy is effective in improving the SFR after ESWL and RIRS, especially for lower calyx stones, upper ureter and renal pelvic stones, while without significant side effects. External physical vibration lithecbole (EPVL) might provide a relative uniformed and repeatable protocol for clinical practice of physical therapy. Review Registration: PROSPERO 2019 CRD42019130228.

Risk factors for urinary infection after retrograde upper urinary lithotripsy

“…However, with the extensive development of intracavitary lithotripsy techniques, various postoperative complications have also followed. Among them, the incidence of postoperative urinary tract infection is higher, the incidence is 10.13% to 30.08%, which may develop into urinary infection related shock, and severe cases may even lead to death [5,6] …”

“…Among them, the incidence of postoperative urinary tract infection is higher, the incidence is 10.13% to 30.08%, which may develop into urinary infection related shock, and severe cases may even lead to death. [5,6] How to reduce or even avoid the incidence of infection during the perioperative period in the treatment of urolithiasis by endourological surgery has been an issue of great concern to urologists in recent years. It has been reported at home and abroad that the use of antibiotics before surgery and the reduction of operative lithotripsy time during surgery can all reduce the rate of urinary tract infection and acute septic shock after surgery to a certain extent, [7] but a considerable proportion of patients still cannot avoid severe urinary tract infection and septic shock.…”