PMID- 29545046 OWN - NLM STAT- MEDLINE DCOM- 20181212 LR - 20181212 IS - 1527-9995 (Electronic) IS - 0090-4295 (Linking) VI - 116 DP - 2018 Jun TI - Modified Mechanical Percussion for Upper Urinary Tract Stone Fragments After Extracorporeal Shock Wave Lithotripsy: A Prospective Multicenter Randomized Controlled Trial. PG - 47-54 LID - S0090-4295(17)31352-3 [pii] LID - 10.1016/j.urology.2017.12.024 [doi] AB - OBJECTIVE: To investigate the effectiveness of modified mechanical percussion for eliminating upper urinary tract stone fragments after extracorporeal shock wave lithotripsy. MATERIALS AND METHODS: We assigned patients aged 18-60 years with upper urinary tract calculi to the modified mechanical percussion (trial) or observation (control) group. Kidney-ureter-bladder radiography and ultrasound were used for diagnostic evaluation. The primary outcome was the stone-expulsion rate (SER) at 6 hours. The first stone-expulsion time, the SER at 3, 12, and 24 hours, the stone-free rate, additional interventions, and adverse events (AEs) were recorded. RESULTS: A total of 120 patients underwent randomization: 60 for each group. The mean first stone-expulsion time in the trial and control groups was 6.75 and 13.58 hours, respectively (P = .001). The SERs at 3, 6, and 12 hours in the trial group were 51.8%, 75.4%, and 76.8%, respectively, which were higher than the control group (all P <.05). Among patients who expelled fragments within 6 hours, the stone-free rates were improved at 1 week (P = .002) and at 2 weeks (P = .000). Patients needed fewer additional interventions in the trial group (P = .035). AEs occurred in 42.9% (24 of 56) and 67.9% (38 of 56) of the patients in the trial and control groups, respectively (P = .008). Age, gender, stone size and location, and SER at 24 hours did not differ significantly among the groups. CONCLUSION: Modified mechanical percussion significantly improved SERs and accelerated stone passage after shock wave lithotripsy, resulting in a stone-free status with a lower risk of AEs and reduced need for additional interventions. CI - Copyright (c) 2018 Elsevier Inc. All rights reserved. FAU - Jing, Suoshi AU - Jing S AD - Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Urological Diseases, Gansu Province (Lanzhou University), Gansu Nephro-Urological Clinical Center, Lanzhou, China. FAU - Liu, Bo AU - Liu B AD - Department of Urology, Wuhan General Hospital of Guangzhou Military Region, Wuhan, China. FAU - Lan, Wengang AU - Lan W AD - Department of Urology, Shenzhen People's Hospital, Second Clinical Medicine School of Jinan University, Shenzhen, China. FAU - Zhao, Xin AU - Zhao X AD - Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Urological Diseases, Gansu Province (Lanzhou University), Gansu Nephro-Urological Clinical Center, Lanzhou, China. FAU - Bao, Junsheng AU - Bao J AD - Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Urological Diseases, Gansu Province (Lanzhou University), Gansu Nephro-Urological Clinical Center, Lanzhou, China. FAU - Ma, Junlin AU - Ma J AD - Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Urological Diseases, Gansu Province (Lanzhou University), Gansu Nephro-Urological Clinical Center, Lanzhou, China. FAU - Liu, Zhimin AU - Liu Z AD - Department of Urology, Wuhan General Hospital of Guangzhou Military Region, Wuhan, China. FAU - Liu, Hongyan AU - Liu H AD - Department of Urology, Shenzhen People's Hospital, Second Clinical Medicine School of Jinan University, Shenzhen, China. FAU - Pan, Tiejun AU - Pan T AD - Department of Urology, Wuhan General Hospital of Guangzhou Military Region, Wuhan, China. FAU - Yang, Jianggen AU - Yang J AD - Department of Urology, Shenzhen People's Hospital, Second Clinical Medicine School of Jinan University, Shenzhen, China. FAU - Wu, Dan AU - Wu D AD - Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Urological Diseases, Gansu Province (Lanzhou University), Gansu Nephro-Urological Clinical Center, Lanzhou, China. FAU - Zhao, Youli AU - Zhao Y AD - Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Urological Diseases, Gansu Province (Lanzhou University), Gansu Nephro-Urological Clinical Center, Lanzhou, China. FAU - Wang, Yuhan AU - Wang Y AD - Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Urological Diseases, Gansu Province (Lanzhou University), Gansu Nephro-Urological Clinical Center, Lanzhou, China. FAU - Wang, Zhiping AU - Wang Z AD - Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Urological Diseases, Gansu Province (Lanzhou University), Gansu Nephro-Urological Clinical Center, Lanzhou, China. Electronic address: erywzp@lzu.edu.cn. LA - eng PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial DEP - 20180312 PL - United States TA - Urology JT - Urology JID - 0366151 SB - IM MH - Adult MH - Drainage, Postural MH - Equipment Design MH - Female MH - Humans MH - Kidney Calculi/*therapy MH - *Lithotripsy/adverse effects/methods MH - Male MH - Middle Aged MH - Particle Size MH - Patient Positioning MH - Percussion/*methods MH - Prospective Studies MH - Ureteral Calculi/*therapy MH - Vibration MH - Young Adult EDAT- 2018/03/17 06:00 MHDA- 2018/12/13 06:00 CRDT- 2018/03/17 06:00 PHST- 2017/09/30 00:00 [received] PHST- 2017/12/20 00:00 [revised] PHST- 2017/12/22 00:00 [accepted] PHST- 2018/03/17 06:00 [pubmed] PHST- 2018/12/13 06:00 [medline] PHST- 2018/03/17 06:00 [entrez] AID - S0090-4295(17)31352-3 [pii] AID - 10.1016/j.urology.2017.12.024 [doi] PST - ppublish SO - Urology. 2018 Jun;116:47-54. doi: 10.1016/j.urology.2017.12.024. Epub 2018 Mar 12.