Inversion, hydration and diuresis during extracorporeal shock wave lithotripsy: Does it improve the stone-free rate for lower pole stone clearance?

Objective: It was the aim of this study to assess the efficacy and safety of combined forced hydration and diuresis with limited inversion during shock wave lithotripsy (SWL) by comparing this treatment modality with conventional SWL for lower calyceal nephrolithiasis. Patients and Methods: In this prospective, non-randomized study, we included 100 patients with lower calyceal calculi ≤2 cm. Fifty of them received conventional SWL and the other 50 underwent SWL combined with oral hydration, diuresis and 12° inversion position during SWL. Intravenous urography was performed for all patients prior to their treatment. Patients in both groups were treated on Dornier™ MPL 9000. Blood pressure monitoring was applied during the SWL session. Follow-up was performed the first and the third month after treatment with plain kidney-ureter-bladder X-ray and kidney-ureter-bladder ultrasound. Results: Clinical outcomes were available in 90 patients. Follow-up at 3 months showed that 83.3% of the patients belonging to the study group were rendered stone free, whereas 71.5% were stone free in the control (p > 0.05). Complications were minimal and not statistically significant. Conclusions: Forced diuresis and inversion therapy is very well tolerated; however, the stone-free rate was not significantly improved.