Department of Urology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu 211100, China..
Department of Urology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu 211100, China.
Urol J. 2021 Feb 24;18(1):19-27. doi: 10.22037/uj.v18i.6417.
The external physical vibration lithecbole (EPVL) is a new device that accelerates the discharge of urinary stones by changing the patient's body position and providing multi-directional simple harmonic waves. It is clinically employed to improve the stone-free rate (SFR). However, it is not widely accepted in clinical practice due to the lack of high-level evidentiary support and a standard protocol. The present meta-analysis aims at the evaluation of the efficacy and safety of EPVL treatment in improving the SFR.
This study was a systematic review and meta-analysis. A systematic literature review was conducted using PubMed, Scopus, Embase, Medline, the Web of Science, and the Cochrane Library to find randomized controlled trials (RCTs) as recent as April 2020 that evaluated the efficacy and safety of EPVL treatment for patients with stones/residual stones in the upper urinary tract.
In total, 7 prospective studies with 1414 patients were included. Compared with patients in the control group, patients treated with an EPVL (the intervention group) had higher SFRs (95% CI: 0.59-0.86, RR = 0.71, P = .0004) and lower complication rates (95% CI: 1.37-3.12, RR = 2.07, P = .0006). In a subgroup analysis based on previous surgery (ESWL, RIRS), the intervention group had an improved SFR as compared to the control group (95% CI: 0.59-0.95, RR = 0.75, P = .02; 95% CI: 0.56-0.73, RR = 0.64, P < .00001, respectively). In a subgroup analysis based on stone location, the SFRs for stones in the upper/middle/lower calyx and renal pelvis were significantly higher in the intervention group than in the control group: for residual stones in the upper and middle calyx, 95% CI: 0.63-0.98, RR = 0.79, and P = .03; for residual stones in the lower calyx, 95% CI: 0.54-0.75, RR = 0.64, and P < .00001; for residual stones in the renal pelvis, 95% CI: 0.47-0.79, RR = 0.61, and P = .0002. However, the SFRs for ureter stones were not significantly different between groups (95% CI: 0.82 -1.05, RR = 0.93, P = .23).
The external physical vibration lithecbole can effectively improve the SFR after ESWL and RIRS without significant side effects, especially for residual stones in the upper/middle/lower calyx and renal pelvis.
外部物理振动碎石术（EPVL）是一种新的设备，通过改变患者的体位并提供多向简单谐波波来加速尿路结石的排出。它在临床上用于提高结石清除率（SFR）。然而，由于缺乏高级别的证据支持和标准方案，它在临床实践中并未得到广泛接受。本荟萃分析旨在评估 EPVL 治疗改善 SFR 的疗效和安全性。
本研究为系统评价和荟萃分析。使用 PubMed、Scopus、Embase、Medline、Web of Science 和 Cochrane Library 进行系统文献综述，以查找截至 2020 年 4 月评估 EPVL 治疗上尿路结石/残留结石患者疗效和安全性的随机对照试验（RCT）。
共纳入 7 项前瞻性研究，共 1414 例患者。与对照组相比，接受 EPVL 治疗的患者（干预组）的 SFR 更高（95%CI：0.59-0.86，RR=0.71，P=0.0004），并发症发生率更低（95%CI：1.37-3.12，RR=2.07，P=0.0006）。基于既往手术（ESWL、RIRS）的亚组分析，干预组的 SFR 优于对照组（95%CI：0.59-0.95，RR=0.75，P=0.02；95%CI：0.56-0.73，RR=0.64，P<.00001）。基于结石位置的亚组分析，干预组上/中/下盏和肾盂结石的 SFR 明显高于对照组：上/中盏残留结石的 SFR 为 95%CI：0.63-0.98，RR=0.79，P=0.03；下盏残留结石的 SFR 为 95%CI：0.54-0.75，RR=0.64，P<.00001；肾盂残留结石的 SFR 为 95%CI：0.47-0.79，RR=0.61，P=0.0002。然而，两组输尿管结石的 SFR 无显著差异（95%CI：0.82-1.05，RR=0.93，P=0.23）。
EPVL 可有效提高 ESWL 和 RIRS 后的 SFR，且无明显副作用，尤其对上/中/下盏和肾盂残留结石效果显著。
