SWL literature
SWL Literature

Xu ZH. et al., 2021: Effect of the External Physical Vibration Lithecbole on the Discharge of Upper Urinary Stones: A Systematic Review and Meta-analysis

Xu ZH, Zhou S, Lv JL, Wang H.
Department of Urology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu 211100, China.
Department of Urology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu 211100, China.
Department of Urology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu 211100, China.
Department of Urology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu 211100, China.

Abstract

Purpose: The external physical vibration lithecbole (EPVL) is a new device that accelerates the discharge of urinary stones by changing the patient's body position and providing multi-directional simple harmonic waves. It is clinically employed to improve the stone-free rate (SFR). However, it is not widely accepted in clinical practice due to the lack of high-level evidentiary support and a standard protocol. The present meta-analysis aims at the evaluation of the efficacy and safety of EPVL treatment in improving the SFR.

Methods: This study was a systematic review and meta-analysis. A systematic literature review was conducted using PubMed, Scopus, Embase, Medline, the Web of Science, and the Cochrane Library to find randomized controlled trials (RCTs) as recent as April 2020 that evaluated the efficacy and safety of EPVL treatment for patients with stones/residual stones in the upper urinary tract.

Results: In total, 7 prospective studies with 1414 patients were included. Compared with patients in the control group, patients treated with an EPVL (the intervention group) had higher SFRs (95% CI: 0.59-0.86, RR = 0.71, P = .0004) and lower complication rates (95% CI: 1.37-3.12, RR = 2.07, P = .0006). In a subgroup analysis based on previous surgery (ESWL, RIRS), the intervention group had an improved SFR as compared to the control group (95% CI: 0.59-0.95, RR = 0.75, P = .02; 95% CI: 0.56-0.73, RR = 0.64, P < .00001, respectively). In a subgroup analysis based on stone location, the SFRs for stones in the upper/middle/lower calyx and renal pelvis were significantly higher in the intervention group than in the control group: for residual stones in the upper and middle calyx, 95% CI: 0.63-0.98, RR = 0.79, and P = .03; for residual stones in the lower calyx, 95% CI: 0.54-0.75, RR = 0.64, and P < .00001; for residual stones in the renal pelvis, 95% CI: 0.47-0.79, RR = 0.61, and P = .0002. However, the SFRs for ureter stones were not significantly different between groups (95% CI: 0.82 -1.05, RR = 0.93, P = .23).

Conclusion: The external physical vibration lithecbole can effectively improve the SFR after ESWL and RIRS without significant side effects, especially for residual stones in the upper/middle/lower calyx and renal pelvis.
Urol J. 2021 Feb 24. doi: 10.22037/uj.v18i.6417. Online ahead of print. PMID: 33638142

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Comments 1

Hans-Göran Tiselius on Wednesday, May 19 2021 08:30

Parallel with the outstanding achievements in stone removal during the past more than 35 years, residual fragments have remained a disturbing and problematic factor. Residuals are encountered after non-invasive as well as low invasive treatment modalities but are most observed after SWL and next to that after RIRS.

Most residuals are found in the lower calyces because of gravity. This shortcoming is commonly caused by an unfavourable anatomy of the lower parts of the renal collecting system. Residual fragments are occasionally sufficiently large to cause obstruction and renal colic, they might aggregate and grow to larger stones with associated clinical problems such as pain, haematuria, and nidus for bacteria. Even when the residuals are asymptomatic, they are not only a “cosmetic” problem but a factor making repeated future follow-up necessary.

Numerous efforts have been undertaken to eliminate residuals in a non-invasive or low-invasive way. Some methods have been more successful than others. The recent Chinese invention Lithecbole (EPVL), with alterations in patient positioning together with vibrations, has proved to be a powerful tool for fragment elimination.

In the current article the authors have systematically evaluated the results of EPVL-treatment obtained from 7 studies in the literature. The outcome was compared between EVPL and controls without any specific efforts of fragment elimination. The bottom-line in the reports of 1414 patients was that EPVL resulted in a significantly higher stone-free rate and lower rate of complications than what was observed in controls. The mean stone-free rate in controls was 71% and in EPVL-treated patients 88% (p=0.0004).

When subgroup analysis was carried out in terms of anatomical locations in the kidney the following recordings might be of interest:

https://www.storzmedical.com/images/blog/Xu_ZH.JPG

Undoubtedly EPVL has the capacity to improve fragment clearance in a way superior to that observed in controls. Nevertheless, there obviously is room for further technical and methodological improvements. This is a field of great importance for maintaining the advantage that SWL offers in terms of non-invasive stone removal.

Hans-Göran Tiselius

Parallel with the outstanding achievements in stone removal during the past more than 35 years, residual fragments have remained a disturbing and problematic factor. Residuals are encountered after non-invasive as well as low invasive treatment modalities but are most observed after SWL and next to that after RIRS. Most residuals are found in the lower calyces because of gravity. This shortcoming is commonly caused by an unfavourable anatomy of the lower parts of the renal collecting system. Residual fragments are occasionally sufficiently large to cause obstruction and renal colic, they might aggregate and grow to larger stones with associated clinical problems such as pain, haematuria, and nidus for bacteria. Even when the residuals are asymptomatic, they are not only a “cosmetic” problem but a factor making repeated future follow-up necessary. Numerous efforts have been undertaken to eliminate residuals in a non-invasive or low-invasive way. Some methods have been more successful than others. The recent Chinese invention Lithecbole (EPVL), with alterations in patient positioning together with vibrations, has proved to be a powerful tool for fragment elimination. In the current article the authors have systematically evaluated the results of EPVL-treatment obtained from 7 studies in the literature. The outcome was compared between EVPL and controls without any specific efforts of fragment elimination. The bottom-line in the reports of 1414 patients was that EPVL resulted in a significantly higher stone-free rate and lower rate of complications than what was observed in controls. The mean stone-free rate in controls was 71% and in EPVL-treated patients 88% (p=0.0004). When subgroup analysis was carried out in terms of anatomical locations in the kidney the following recordings might be of interest: [img]https://www.storzmedical.com/images/blog/Xu_ZH.JPG [/img] Undoubtedly EPVL has the capacity to improve fragment clearance in a way superior to that observed in controls. Nevertheless, there obviously is room for further technical and methodological improvements. This is a field of great importance for maintaining the advantage that SWL offers in terms of non-invasive stone removal. Hans-Göran Tiselius
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Tuesday, July 27 2021

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