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.