Comparison of Lower Pole Renal Calculi Clearance after Extracorporeal Shock Wave Lithotripsy with and without percussion, diuresis and inversion maneuver

Aims: To determine whether Percussion, diuresis and inversion (PDI) maneuver following shock wave lithotripsy (SWL) can enhance stone clearance from lower calyx as compared to SWL alone. Methods: 60 Patients with lower pole stones (8-15 mm) were randomized to SWL plus PDI (group A) or SWL alone (group B). Shock waves were delivered to all patients according to a standard protocol. Group A patients underwent PDI maneuver immediately after SWL session. Stone clearance was determined by digital KUB x-ray 2 weeks after SWL. Results: Stone clearance rate (SCR) was 65.5% in SWL plus PDI patients as compared to 34.5% in SWL only Patients. This difference is statistically highly significant (p<.02). Relative Risk (RR) of stone clearance with PDI is 1.9 (95% CI1..07-3.35) as compared to SWL alone. Conclusion: PDI in conjunction with SWL significantly improves stone clearance (65.5%) from lower pole of kidney. This means 1.9 times improvement in SCR with virtually no additional cost.