The effect of percussion, diuresis and inversion therapy on retrograde intrarenal surgery success for lower renal pole stones: a prospective randomized controlled study

Abstract Inversion of the patient, forced diuresis after hydration, and mechanical percussion technique was developed for lower renal pole (LRP) stones with extracorporeal shock wave (ESWL) by considering the geometric obstacles to reverse the factors that complicate the removal of stones. In this study, we aimed to analyze the effect of percussion, diuresis and inversion (PDI) therapy on the success rates of retrograde intrarenal surgery (RIRS) for the LRP stones. 114 patients who underwent RIRS for LRP stones < 2cm were included in this study. Patients' age, gender, body mass index (BMI), preoperative double J (DJ) stent presence, ESWL history, operation time, stone size, number, density, number (single or multiple), side (left-right), infundibulopelvic angle (IPA), infundibular length (IL), infundibular width (IW) and success status were recorded prospectively. The patients were divided into two groups. One group received RIRS procedure only (non-PDI group) and the other group received PDI therapy after the RIRS procedure (PDI group). Two groups were compared in terms of the parameters above. PDI was performed to 60 (52.6%) patients, and not performed to 54 (47.4%) patients. The success rate (58.3%) for the PDI group was higher than the non-PDI group (25.9%), and this difference was statistically significant (p < 0.001). In multivariate logistic regression analysis, stone size (OR = 1.306; 95% CI = 1.019–1.674; p < 0.001), IU (OR = 1.702; 95% CI = 1.383–2.096; p < 0.001) and not performing PDI therapy (p < 0.001) OR = 9.455; 95% Cl = 2.426–10.853; p = 0.001) were revealed to be independent risk factors for failure. In conclusion, PDI therapy increases the success rates of RIRS performed for the LRP stones.