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TAIPEI, TAIWAN ( - Introduction and Objectives: Various adjunctive measures have been tested to improve the stone free rates (SFR) for lower pole stones (LPS), but few are randomised or controlled. We report the results of addition of an adjunctive measure (inversion 30 degree head down Trendelenbugh position) to improve the SFR of LCS.

wceMethods: Patients with LCS (4–20 mm) were recruited and randomized to either shockwave lithotripsy (SWL) or SWL with simultaneous inversion therapy. Standardized shockwaves were given to all patients stratified into 3 categories pending stone size. Additional shockwaves were given to patients with stone fragments at day 2, weeks 2, 4, 12, 24 and at 1 year.

Results: A total of 140 patients were recruited. Patients were comparable with respect to age, sex, race and stone parameters. The overall SFR at week 12 was 72% (n = 49/68) in patients with SWL and 76% (n = 54/71) in SWL with simultaneous inversion at the end of study. SFR of SWL versus SWL with simultaneous inversion was not statistically significant, and no significant adverse effects were noted in both groups of patients. SFR was better in stone of smaller sizes, with a 79%SFR for stones < 10 mm, 75% for stones 11–15 mm and 55% SFR for stones 16–20 mm.

Conclusions: Although not statistically significant, SWL with simultaneous inversion is a valuable adjunct in assisting the passage of lower pole renal stones with a SFR of 76%. In clinic practice, this also translates to a 5% improvement in SFR with no added cost.

Source of Funding: None

Listen to an interview with Shaun Lee, one of the authors of this study.


Presented by Shaun Lee,1 Wing Seng Leong,2 and Men Long Liong3 at the 32nd World Congress of Endourology & SWL - September 3 - 7, 2014 - Taipei, Taiwan

1Monash University, Malaysia
2Lam Wah Ee, Malaysia
3Island Hospital, Malaysia


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