Objectives. - To evaluate the feasibility, efficiency, and predictive factors of therapeutic suc-cess of Vibration, Diuresis and Inversion (VDI) therapy for the removal of upper urinary tract stones.Methods. - It is a retrospective, single-center study at the CHU -La Conception, Marseille, France including all patients treated with VDI from 2013 to 2018. VDI was indicated for stones <6 mm in first-line treatment or for residual fragments <6 mm after ureteroscopy, PCNL, microPCNL. The protocol included 4 sessions in outpatient care from 2013 to 2015 then 6 sessions from 2015 to 2018 and a final radiological evaluation.Results. - In total, 109 patients or 489 sessions are reported: median age was 55 years [14-84], median BMI 25 kg/m2 [15-37], average cumulative size of kidney stones 3 mm +/- 4. VDI was performed after flexible ureteroscopy (62%), SWL (20%), percutaneous treatment (9%) or as first-line treatment (9%). Compliance was 87 %. The median VAS during the session was 0[0-8]. The incidence of post-session renal colic was 4% (all Clavien I). The postoperative fragment free and microfragment rates were respectively 39% and 21%, i.e. an overall success of 60% for kidney stones, and 43% and 21%, i.e. an overall success of 64% for lower pole kidney stones.Conclusion. - VDI is a simple, non invasive and well tolerated technique for the elimination of small renal lithiasis after SWL, ureteroscopy, PCNL or as a first-line treatment.(c) 2022 Elsevier Masson SAS. All rights reserved.

La lithotritie extracorporelle (LEC) et l’urétéroscopie souple (URSS) sont les deux traitements de référence des calculs rénaux. Ces deux thérapies peuvent laisser des fragments caliciels résiduels, difficiles à éliminer, augmentant au long cours le risque de complications et de ré-intervention. Actuellement il n’existe aucun traitement adjuvant à la LEC ou à l’URSS optimisant l’élimination de ces fragments. En 2005 Chiong et al. ont rapporté une technique associant kinésithérapie en position de Trendelenburg et hyperdiurèse (posturothérapie) afin d’augmenter la clairance de ces fragments. Depuis deux ans nous prescrivons la posturothérapie aux patients le désirant pour les calculs/fragments caliciels moyens et inférieurs de moins de 5mm.

IntroductionDespite many advances, the management of renal stones - especially lower caliceal stones (LCS) - remains a challenge. The gravity-dependent location of the lower calices hinders the spontaneous clearance of fragments, which can be a nidus for future growth and symptomatic recurrence. Currently, there is no standard adjunctive therapy to facilitate fragment passage.ObjectivesTo report the safety and effectiveness of mechanical percussion diuresis and inversion (PDI) therapy for eliminating renal stones in children.Patients and MethodsSince November 2013, children with residual fragments (after shock wave lithotripsy or flexible ureteroscopy) or native symptomatic renal stones were prospectively included in a protocol of four PDI sessions. After giving written consent, the children drank 10 ml/kg of water 30 min before therapy. They then laid in a prone Trendelenburg position on a couch angled at 45 degrees and received continuous 10-min mechanical percussion applied over the affected flank by a physiotherapist (Figure summary). Tolerance stone burden reduction and stone clearance were documented with ultrasound 4 weeks after the last session.ResultsSeventeen participants, with a median age of 10.8 years (range 18 months to 18 years), received 82 PDI sessions performed over 22 months. The median stone diameter was 5mm (range 3-9). All children tolerated the PDI therapy well. Over a median follow-up of 11 months (range 3-18), no significant adverse effects were noted. The overall stone-free rate was 65%. Four of the six patients with residual fragment passed their fragments. The patients who did not become stone free by PDI experienced a decrease in fragment size of 57% (range 34-71). The observance rate was 100%.DiscussionMany studies have demonstrated that the gravity-dependent position of the lower calyces appears to be an important factor limiting the clearance of LCS. Positioning patients with a degree of inversion in order to put the collecting system beyond the horizontal plane affected the LCS through gravitational force. Complications were rare. PDI appeared to save costs and have similar success rates as shock wave lithotripsy for native small renal stones in children.ConclusionPDI is safe and effective for facilitating gravity-dependent drainage of renal stones and provides an opportunity to treat children in a quick, non-invasive, economic, painless, non-radiative and diverting fashion. This therapy is a valuable alternative in the pattern of stone management. In case of persistent fragments, it is recommend that the number of sessions be increased to six.