| Summary: | 碩士 === 國立臺灣大學 === 預防醫學研究所 === 98 === Background and Objectives:
Treating lower pole renal stones with shockwave lithotripsy can result in incomplete stone clearance due to poor drainage of residual stone fragments, leading to recurrent stone formation. Clinically we can use the adjunct treatments, such as diuresis, gravity therapy or percussion to facilitate the stone passage. The objectives of this study is to determine whether percussion, diuresis and inversion (PDI) therapy can improve the clearance rate of lower pole renal stone after shockwave lithotripsy.
Methods:
114 patients with lower pole renal stone who received shockwave lithotripsy were arranged into two groups. One group (n=58) received shockwave treatment alone, and the other group (n=56) received shockwave lithotripsy followed by weekly PDI therapy (range 1 to 4). PDI therapy was performed as follows. Patient drank 500ml water and received 20mg Furosemide injection. After 30 minutes, they lay in prone position with upper trunk 45°downward to the ground. A vibrator was applied over the flank and subjects received vibration therapy for 10 minutes. Patients received follow up one month and three months after the shockwave lithotripsy. Stone clearance and residual stone characteristics were documented with plain abdominal radiography.
Result:
There were no significant differences in both groups while comparing demographics, total stone diameter, radiological features (infundibular neck diameter, infundibular length, caliceal height, infundibular-pelvic angles, infundibular-ureteral angles, infundibular-vertebral angles, cortical thickness) and shockwave parameters (shockwave intensity and duration). The radiologically documented complete stone clearance rates were significantly different in one months (control vs PDI: 19.0% vs 35.7%, p=0.045) and three months (control vs PDI: 24.1% vs 48.2%, p=0.006). There was also significant difference in change of stone area between two groups in one month (23.4% v.s. 68.7%, p<0.001) and three months (27.9% v.s. 82.5%, p<0.001).
The predictors for one month stone clearance were initial stone area (OR=0.95, 95% CI 0.91－0.99) and infundibular-pelvic angle (OR=1.07, 95% CI 1.01－1.15). The predictors for three month stone clearance were initial stone area (OR=0.95, 95% CI 0.92－0.99), infundibular neck diameter (OR=2.50, 95% CI 1.32－4.75) and infundibular-pelvic angle (OR=1.07, 95% CI 1.01－1.13).
Conclusion:
Percussion, diuresis and inversion therapy is effective in assisting the clearance of lower pole renal stone after shockwave lithotripsy.
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