Efficacy of vibrotherapy in urolithiasis after lithotripsy or intrarenal surgery

In order to fragment the urine stone extracorporeal shock wave lithotripsy (SWL) and retrograde intrarenal surgery (RIRS) are used. The fragmentation of the urinary stone helps to naturally expel it in the urine. However, the residual stone fragments remaining after SWL or RIRS may be difficult to remove and constitute a source of infection and obstruction. Moreover, those that remain asymptomatically may grow back, leading to the recurrence of urolithiasis. Therefore, it is necessary to support the excretion of residual stone fragments after SWL or RIRS. Attempts have been made to use mechanical vibrations for this purpose in the form of EPVL (external physical vibration lithecbole) vibrotherapy, but this method requires objective evaluation, which is why Chinese scientists from Sichuan University conducted a systematic review and meta-analysis of scientific articles, assessing the effectiveness and safety of the EPVL vibrotherapy after SWL or RIRS in urolithiasis.

• EPVL seems to be an effective and tolerable therapy significantly increasing the values ​​of stone-free rate (SFR) both after SWL and after RIRS in patients with urolithiasis.
• Large-scale randomized multicentre trials are still required to provide more robust evidence.

Prepared on the basis of:

Efficacy and Safety of External Physical Vibration Lithecbole After Extracorporeal Shock Wave Lithotripsy or Retrograde Intrarenal Surgery for Urinary Stone: A Systematic Review and Meta-analysis. Yuan C, Jian Z, Jin X et al. J Endourol. 2021 May;35(5):712-720.

Study population

Six randomized controlled trials including 853 patients with urolithiasis were qualified for the analysis.

Test procedure

Articles subjected to meta-analysis were searched in the EMBASE, Cochrane Library, PubMed, ScienceDirect, ClinicalTrials.gov and Web of Science databases (published until February 2020). Stone-free rate (SFR) and complication rates were analyzed.

Use of vibration in the study

Mechanical vibrations in the treatment of urolithiasis were first used in 1965. Today, they are often recommended to improve SFR and accelerate the expulsion of stones after SWL. For this purpose, EPVL has been used for years. Before the therapy, patients must drink 1000-3000 ml of water and lie on the bed in a lateral or prone position, without anesthesia. The oscillators then generate harmonic vibrational waves from many directions (power 20 W, frequency 46 – 58 Hz, amplitude 5 mm) to separate the stones from the kidney or ureter. The angle of the bed can be adjusted to vary the relative position of the stones and allow the stones to discharge smoothly. The entire process is monitored by ultrasound.

Results

In patients who received SWL, EPVL vibrotherapy increased SFR within 3 weeks (RR = 1.17, 95% CI: 1.06-1.29, P = 0.001) and over 3 weeks (RR = 1.19, 95% CI: 1.03-1.37, P = 0.02).

In patients who received RIRS, EPVL vibrotherapy also increased SFR within 3 weeks (RR = 1.84, 95% CI: 1.35-2.49, P <0.0001) and over 3 weeks (RR = 1.53, 95% CI: 1.33-1.77, P <0.00001).

The overall complication rate did not differ significantly in the EPVL + RIRS group versus RIRS without vibrotherapy, but it was 1.38 times higher in the EPVL + SWL group versus SWL without vibrotherapy (RR = 1.38, 95% CI: 1.06-1.79, P = 0.02), especially considering the incidence of pain in the lumbar region (RR = 3.11, 95% CI: 1.02-9.46, p = 0.05).

Comment

EPVL vibrotherapy effectively and safely complements SWL or RIRS therapy in patients with urolithiasis, not increasing complications after RIRS, but increasing their percentage by 1.38 times after SWL.

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