Abstract
Background
Stone-free rate (SFR) after lithotripsy was one of the most frequent concerned issue, especially in patients following extracorporeal shockwave lithotripsy (ESWL) and flexible ureteroscopy (retrograde intrarenal surgery, RIRS). Physical therapy including percussion, inversion, physical vibration and their combinations was administrated to improve the SFR, but there was no conclusive evidence to support this theory. To conclude the effectiveness and safety of physical therapy on the SFR in patients received ESWL/RIRS.
Methods
We systematically reviewed the literature focused on physical therapy in patients after ESWL/RIRS on PubMed, Scopus, Cochrane library and Embase from 2000 to 2019 April. We mainly focused on stone-free rate and complications rate.
Results
Nine prospective studies including 8 randomized control trials and 1 non-randomized study were enrolled, and 1747 subjects were analyzed. All the physical therapy we enrolled was finally concluded into EPVL (external physical vibration lithecbole) and PDI (percussion, diuresis and inversion). Compared to conventional group, physical therapy provided a higher SFR (OR: 2.68; 95% CI: 1.74–4.12; P = 0.0001), especially SFR in lower calyx stones (OR: 3.60; 95% CI: 2.26-5.73; P= 0.0001). In subgroup analysis, EPVL (OR: 2.28; 95% CI: 1.27–4.07; P =0.005) and PDI (OR: 3.51; 95% CI: 1.96–6.26; P = 0.0001) were both effective. Drinking e enough water before treatment was supposed to increase the SFR (OR: 3.31; 95% CI: 2.39–4.60; p = 0.0001). Otherwise, medical intervention such as furosemide (OR: 5.21; 95% CI: 0.53–50.72; P = 0.156) and tamsulosin (OR: 1.05; 95% CI: 0.61–1.82; P = 0.855) did not improve the SFR. No significant difference was detected in terms of complications rates (OR: 0.83; 95% CI: 0.61–1.14; P = 0.25).
Conclusions
EPVL or PDI were both effective and safe in increasing the SFR after ESWL/RIRS, but its effectiveness was limited in LCS. Drinking enough water before physical therapy helped to improve the SFR. The role of furosemide and tamsulosin in physical therapy or surgery need to be testified by large-scale, high-quality studies.