Vibrotherapy improves the effectiveness of flexible ureteroscopy in removing urinary calculi

Ureteroscopy is commonly used to treat upper urinary tract calculi, a common disease of the urinary tract. Previous studies have shown that the application of external physical vibration can significantly improve the effectiveness and speed of lithotripsy stones removal. Therefore, the aim of the presented research by Chinese scientists was to compare the therapeutic effects of ureteroscopy alone with the effects of using the same therapy and additionally vibrotherapy (administering external physical vibrations).

• Vibrotherapy improved the percentage of stones in urine on the next day after treatment, which was 100% in the experimental group (ureteroscopy+vibrotherapy), and 29.7% in the control group (ureteroscopy).
• The day after treatment and 1 or 2 weeks after treatment in the experimental group, the clearance rate was 71.2, 87.7 or 95.9%, respectively, significantly exceeding the clearance rate in the control group: 6.8, 43.8, 64.4%, respectively.
• The studied kidney functions improved after both treatments, but especially in the experimental group.
• The percentage of people without stones during the one-year follow-up in the experimental group (97.3%) was higher than in the control group (83.6%).

Prepared on the basis of:

Therapeutic effects of flexible ureteroscopy alone and in combination with external physical vibration on upper urinary tract calculi: a randomized controlled trial. Tan C, Jiang Y, Song S et al. Wideochir Inne Tech Maloinwazyjne. 2021 Sep;16(3):536-542.

Study population

The study involved 146 patients with the upper urinary tract calculi.

Test procedure

The patients were randomly assigned to the control group (49 men and 24 women aged 21-78 years, mean 45.4 ± 10.6 years) or the experimental group (46 men and 27 women aged 20-76 years, mean 46.1 ± 11.2 years). The control group and the experimental group received flexible ureteroscopy, moreover, the experimental group also additionally received vibrotherapy in the form of external physical vibrations.

The incidence of complications, the frequency of finding stones in the urine the day after treatment, clearance, stone composition, as well as the levels of renal function indicators: blood urea nitrogen (BUN) and serum creatinine (Scr) were compared. The percentage of people without stones during the annual follow-up was also analyzed using the Kaplan-Meier method.

Use of vibration in the study

In properly positioned patients on the treatment bed, external physical vibration generators (Zhengzhou Kang Baijia Technology Co., Ltd.) were used – main and auxiliary vibrators. The frequency of vibrations of the main vibrator was 50 Hz, and of the auxiliary one – 30 Hz. The amplitude of both was 5 mm. The pressure force was adjusted to the patient’s condition. The vibrators worked to push the stones into the renal pelvis, and then the bed was tilted so that the patient’s head was raised and the legs were lowered and the vibration continued to push the stones along the renal pelvis and ureter for about 8-10 minutes. In the following days and weeks, 1 or 2 cycles of vibrotherapy were performed, but not more than 3.

Results

The rate of finding stones in the urine on the day after treatment was higher in the experimental group (100%) than in the control group (29.7%) (p <0.05).

The day after treatment and 1 or 2 weeks after the treatment, in the experimental group the clearance rate was 71.2%, 87.7% or 95.9%, respectively. These values were higher than in the control group (6.8%, 43.8%, 64.4%, respectively; p <0.05).

BUN and Scr levels decreased after both treatments, especially in the experimental group (p <0.05).

The percentage of people without stones during the one-year follow-up in the experimental group (97.3%) was higher than in the control group (83.6%; p <0.05).

Comment

Vibrotherapy in the form of external physical vibrations significantly improved the therapeutic effects of the flexible ureteroscopy, and, when used in conjunction with flexible ureteroscopy, improved the indicators of kidney function (BUN, Scr) and reduced the rate of stone regeneration compared to flexible ureteroscopy.

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