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| |  DG DISPATCH - AUA: Mechanical percussion shows promise for post-lithotripsy kidney stone fragments By Emma Patten Special to DG news
ATLANTA, GA -- May 4, 2000 -- A novel treatment to remove residual lower calyceal stone fragments after lithotripsy shows promise as being safe and effective, researchers report. Kenneth T. Pace, MD, and colleagues from the University of Toronto, in Canada, presented their findings on Wednesday (May 3) at the American Urological Association’s 95th annual conference, in Atlanta, GA. The treatment, known as mechanical percussion, inversion and diuresis (MPI) is a novel technique for removing kidney stones. Following shock wave lithotripsy (SWL), tiny fragments can remain in the bottom portion of the kidney. Often, these sandy particles will pass out of the kidney, but sometimes they do not. When the particles remain, they can cause infection, kidney pain, or they can enlarge over time to cause kidney stones. "Unfortunately, there is no simple treatment, (other than MPI) to eliminate these sandy particles," remarked Dr. Pace. To perform the study, the team examined 34 patients who had undergone SWL three months previously, with residual fragments measuring < 4mm in the lower calyx. Twenty-one patients were randomized to receive MPI or and 13 were randomized to observation alone for one month. The observation group then received MPI if stone fragments persisted. The MPI group had a substantially higher stone-free rate than did the observation group (Chi-square <0.05). The MPI patients also showed a greater improvement in their total stone burden (as measured by stone area) than did the controls. No significant adverse effects were noted in the MPI group. After MPI, nearly 50 percent of the patients were stone free, and the stone burden decreased by about 70 percent in the remainder of the patients. "Our study is important because it shows, for the first time, that MPI works better than just observing these particles. It also shows that about 50 percent of the patients can be rendered stone free," Dr. Pace told Doctor's Guide. "We were not too surprised by these results, because a pilot study by R.J. Honey, MD, (also an author on this paper) demonstrated two years ago that MPI could work. This randomized, controlled trial confirms that finding," he said.
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