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    Vibration therapy promising for treating stone fragments

    51% stone-free rate observed by week 5 of prospective, randomized, controlled trial

     

    Significant increase in stone-free rate seen

    There was a significant and sustained increase in the stone-free rates at weeks 2, 3, and 5 (based on KUB or US or computed tomography scan) between controls and the EPVL group at week 2: 31% versus 53%; week 3: 51% versus 71%; week 5: 59% versus 90%. Most of the benefit was noted in patients with lower pole, renal pelvis or with multiple fragments. There was no difference in stone-free rates for patients with upper or middle calyceal fragments, but the fragments were expelled earlier in the EPVL group.

    In addition to the accelerated stone passage, the ongoing hematuria and urinary leukocytosis were lower in the EPVL group at week 3 and 5, presumably because there were fewer fragments left to cause these symptoms. The procedure requires no anesthesia as it is totally noninvasive and appears to be well tolerated as no side effects related to EPVL were reported.

    Read: Testis Ca care deviates from guidelines in 30% of patients

    Other studies have reported variable degree of success while using interventions such as inversion, activity, percussion, medications, and hydration. The current study appears to combine several of these measures into one and more importantly, EPVL appears to be an active intervention that monitors the propulsion of the fragments into the ureter/bladder during the procedure. These authors had previously reported similarly improved outcomes with use of EPVL after ESWL (J Urol 2015; 195:965).

    While some questions remain about the use of imaging modality (KUB, US), the length of follow-up beyond 5 weeks, and any complications in the control group, this approach (once validated and externally reproducible) has the potential to significantly reduce the morbidity associated with upper tract stone management.

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