| OBJECTIVE: To investigate the effectiveness and safety of modified mechanical percussion for eliminating upper urinary tract stone fragments after extracorporeal shock wave lithotripsy(SWL).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.All patients were subjected to SWL once.Then,the patients in the trial group underwent 2 sessions of modified mechanical percussion or conservative therapy in the control group.The patients were reassessed 1 and 2 weeks after SWL.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=0.001).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<0.05).Among patients expelled fragments within 6 hours,the stone-free rates in the trial and control group at 1 week and 2 weeks were 51.8% and 23.2%(p=0.002)and 55.4% and 23.2%(p=0.000),respectively.Patients needed fewer additional interventions in the trial group(p=0.035).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=0.008).Age,gender,stone size and location,and SER at 24 hours did not differ significantly among the groups.CONCLUSIONS: Modified mechanical percussion significantly improved SERs and accelerated stone passage after SWL,resulting in a stone-free status,and reduced need for additional interventions with a lower risk of AEs. |
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