{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:27:45Z","timestamp":1786969665512,"version":"build-2736575974"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005639","name":"Universidade De S\u00e3o Paulo","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005639","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World J Urol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Patients with lower pole stones (LPS) present a significant challenge for urologists because of the increased likelihood of residual fragments and recurrence following extracorporeal shockwave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS). Although percussion, diuresis, and inversion (PDI) therapy has demonstrated potential for enhancing the stone-free rate (SFR) in these patients, its application remains a topic of debate. Consequently, our objective was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate SFR outcomes when comparing PDI therapy with observation in patients with LPS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>A systematic search was performed using PubMed, Embase, and Cochrane Library. We excluded conference abstracts, non-RCT trials, and studies that used the Lithecbole device. The main outcome was SFR, which was defined per study as no visible stone or residual fragments\u2009\u2264\u20092\u20134\u00a0mm. Risk of bias was assessed using the Cochrane RoB-2 tool and statistical analysis was performed using Review Manager 5.4.1 (Cochrane Collaboration).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Five RCTs comprising a total of 394 patients with LPS were included in this meta-analysis. Of these, 208 (52.7%) underwent PDI therapy; within the PDI group, 60 (28.8%) underwent RIRS and 148 (71.1%) underwent ESWL. The follow-up period ranged from 2 weeks to 3 months. Three studies reported the mean infundibular-pelvic angle and infundibular length; there was no significant difference between PDI and control (25.9 vs. 24.8\u00a0mm;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.83) and (69.1 vs. 69.9 degrees;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.20), respectively. The meta-analysis revealed a statistically significant difference in SFR (OR 3.81; 95% CI 2.40, 6.06;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.00001; I\u00b2=0%; Fig.\u00a02). Furthermore, there was no significant difference in the overall complication rate between groups (OR 0.36; 95% CI 0.04, 3.56;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.38; I\u00b2=0%; Fig.\u00a03). No study reported complications of Clavien-Dindo grade III or higher.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In conclusion, PDI therapy after ESWL or RIRS was associated with a higher short-term SFR in patients with LPS compared with observation. These findings suggest a potential benefit of PDI as an adjunctive strategy for patients with LPS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00345-026-06656-y","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:00:46Z","timestamp":1786968046000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Percussion, diuresis, and inversion therapy can facilitate lower renal pole stone passage after extracorporeal shock wave lithotripsy and retrograde intrarenal surgery? A systematic review and meta-analysis of randomized controlled trials"],"prefix":"10.1007","volume":"44","author":[{"given":"Luiz G. S.","family":"Gimenez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni S.","family":"Marchini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio C. M.","family":"Torricelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Danilovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos A.","family":"Batagello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio C.","family":"Vicentini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William C.","family":"Nahas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Mazzucchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"issue":"9","key":"6656_CR1","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1007\/s00345-017-2008-6","volume":"35","author":"I Sorokin","year":"2017","unstructured":"Sorokin I, Mamoulakis C, Miyazawa K, Rodgers A, Talati J, Lotan Y (2017) Epidemiology of stone disease across the world. World J Urol 35(9):1301\u20131320. https:\/\/doi.org\/10.1007\/s00345-017-2008-6","journal-title":"World J Urol"},{"issue":"2","key":"6656_CR2","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1007\/s40620-016-0283-8","volume":"30","author":"PM Ferraro","year":"2017","unstructured":"Ferraro PM, Curhan GC, D\u2019Addessi A, Gambaro G (2017) Risk of recurrence of idiopathic calcium kidney stones: analysis of data from the literature. J Nephrol 30(2):227\u2013233. https:\/\/doi.org\/10.1007\/s40620-016-0283-8","journal-title":"J Nephrol"},{"issue":"1","key":"6656_CR3","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1046\/j.1464-410x.1998.00684.x","volume":"82","author":"AS Cass","year":"1998","unstructured":"Cass AS, Grine WB, Jenkins JM, Jordan WR, Mobley TB, Myers DA (1998) The incidence of lower-pole nephrolithiasis\u2013increasing or not? Br J Urol 82(1):12\u201315. https:\/\/doi.org\/10.1046\/j.1464-410x.1998.00684.x","journal-title":"Br J Urol"},{"issue":"10","key":"6656_CR4","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1016\/S1726-4901(08)70157-6","volume":"71","author":"CC Lin","year":"2008","unstructured":"Lin CC, Hsu YS, Chen KK (2008) Predictive factors of lower calyceal stone clearance after extracorporeal shockwave lithotripsy (ESWL): the impact of radiological anatomy. J Chin Med Assoc 71(10):496\u2013501. https:\/\/doi.org\/10.1016\/S1726-4901(08)70157-6","journal-title":"J Chin Med Assoc"},{"issue":"6","key":"6656_CR5","doi-asserted-by":"publisher","first-page":"2002","DOI":"10.1016\/j.juro.2014.12.026","volume":"193","author":"FCM Torricelli","year":"2015","unstructured":"Torricelli FCM, Marchini GS, Yamauchi FI, Danilovic A, Vicentini FC, Srougi M et al (2015) Impact of renal anatomy on shock wave lithotripsy outcomes for lower pole kidney stones: results of a prospective multifactorial analysis controlled by computerized tomography. J Urol 193(6):2002\u20132007. https:\/\/doi.org\/10.1016\/j.juro.2014.12.026","journal-title":"J Urol"},{"issue":"8","key":"6656_CR6","doi-asserted-by":"publisher","first-page":"CD007044","DOI":"10.1002\/14651858.CD007044.pub4","volume":"8","author":"V Setthawong","year":"2023","unstructured":"Setthawong V, Srisubat A, Potisat S, Lojanapiwat B, Pattanittum P (2023) Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev 8(8):CD007044. https:\/\/doi.org\/10.1002\/14651858.CD007044.pub4","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"6656_CR7","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1016\/s0022-5347(17)37226-9","volume":"147","author":"FJ Sampaio","year":"1992","unstructured":"Sampaio FJ, Aragao AH (1992) Inferior pole collecting system anatomy: its probable role in extracorporeal shock wave lithotripsy. J Urol 147(2):322\u2013324. https:\/\/doi.org\/10.1016\/s0022-5347(17)37226-9","journal-title":"J Urol"},{"issue":"1","key":"6656_CR8","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1590\/S1677-5538.IBJU.2020.1023","volume":"48","author":"E Mazzucchi","year":"2022","unstructured":"Mazzucchi E, Berto FCG, Denstedt J, Danilovic A, Batagello CA, Torricelli FCM et al (2022) Treatment of renal lower pole stones: an update. Int Braz J Urol 48(1):165\u2013174. https:\/\/doi.org\/10.1590\/S1677-5538.IBJU.2020.1023","journal-title":"Int Braz J Urol"},{"issue":"6","key":"6656_CR9","doi-asserted-by":"publisher","first-page":"1070","DOI":"10.1016\/j.urology.2004.12.045","volume":"65","author":"E Chiong","year":"2005","unstructured":"Chiong E, Hwee S, Kay L, Liang S, Kamaraj R, Esuvaranathan K (2005) Randomized controlled study of mechanical percussion, diuresis, and inversion therapy to assist passage of lower pole renal calculi after shock wave lithotripsy. Urology 65(6):1070\u20131074. https:\/\/doi.org\/10.1016\/j.urology.2004.12.045","journal-title":"Urology"},{"issue":"6","key":"6656_CR10","doi-asserted-by":"publisher","first-page":"2065","DOI":"10.1016\/S0022-5347(05)65507-3","volume":"166","author":"KT Pace","year":"2001","unstructured":"Pace KT, Tariq N, Dyer SJ, Weir MJ, D\u2019A Honey RJ (2001) Mechanical percussion, inversion and diuresis for residual lower pole fragments after shock wave lithotripsy: a prospective, single blind, randomized controlled trial. J Urol 166(6):2065\u20132071","journal-title":"J Urol"},{"key":"6656_CR11","doi-asserted-by":"publisher","first-page":"7870425","DOI":"10.1155\/2024\/7870425","volume":"2024","author":"N Patel","year":"2024","unstructured":"Patel N, Roe A, Stanton D, Roberts J, Kothari A (2024) SLAP Trial: Shock Wave Lithotripsy and Mechanical Percussion Therapy Post ESWL for Renal Calculi. Adv Urol 2024:7870425. https:\/\/doi.org\/10.1155\/2024\/7870425. Published 2024 Mar 26","journal-title":"Adv Urol"},{"issue":"1","key":"6656_CR12","first-page":"293","volume":"9","author":"M Saleem","year":"2015","unstructured":"Saleem M, Younis M, Khan J, Khan M (2015) Comparison of lower pole renal calculi clearance after extracorporeal shock wave lithotripsy with and without percussion, diuresis and inversion maneuver. Pakistan J Med health Sci 9(1):293\u2013295","journal-title":"Pakistan J Med health Sci"},{"issue":"4","key":"6656_CR13","doi-asserted-by":"publisher","first-page":"325","DOI":"10.5173\/ceju.2023.189","volume":"76","author":"C Sarioglu","year":"2023","unstructured":"Sarioglu C, Senel S, Uzun E, Polat ME, Ceviz K, Odabas O et al (2023) The effect of percussion, diuresis and inversion therapy on RIRS success for lower renal pole stones. Cent Eur J Urol 76(4):325\u2013330. https:\/\/doi.org\/10.5173\/ceju.2023.189","journal-title":"Cent Eur J Urol"},{"key":"6656_CR14","unstructured":"Higgins J, Thomas J, Chandler J, Cumpston M, Li T, Page M et al Cochrane Handbook for Systematic Reviews of Interventions version 6.4 (updated August 2023). Cochrane, 2023. [Internet]. Available from: www.training.cochrane.org\/handbook"},{"key":"6656_CR15","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","volume":"372","author":"MJ Page","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71","journal-title":"BMJ"},{"key":"6656_CR16","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1186\/1471-2288-14-135","volume":"14","author":"X Wan","year":"2014","unstructured":"Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range. BMC Med Res Methodol 14:135. https:\/\/doi.org\/10.1186\/1471-2288-14-135","journal-title":"BMC Med Res Methodol"},{"issue":"6","key":"6656_CR17","doi-asserted-by":"publisher","first-page":"1785","DOI":"10.1177\/0962280216669183","volume":"27","author":"D Luo","year":"2018","unstructured":"Luo D, Wan X, Liu J, Tong T (2018) Optimally estimating the sample mean from the sample size, median, mid-range, and\/or mid-quartile range. Stat Methods Med Res 27(6):1785\u20131805. https:\/\/doi.org\/10.1177\/0962280216669183","journal-title":"Stat Methods Med Res"},{"issue":"2","key":"6656_CR18","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","volume":"240","author":"D Dindo","year":"2004","unstructured":"Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205\u2013213. https:\/\/doi.org\/10.1097\/01.sla.0000133083.54934.ae","journal-title":"Ann Surg"},{"key":"6656_CR19","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1186\/s12894-020-00664-9","volume":"20","author":"L Peng","year":"2020","unstructured":"Peng L, Wen J, Zhong W, Zeng G (2020) Is physical therapy effective following extracorporeal shockwave lithotripsy and retrograde intrarenal surgery: a meta-analysis and systematic review. BMC Urol 20:93. https:\/\/doi.org\/10.1186\/s12894-020-00664-9","journal-title":"BMC Urol"},{"issue":"2","key":"6656_CR20","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1016\/s0090-4295(99)00527-0","volume":"55","author":"RJD Honey","year":"2000","unstructured":"Honey RJD, Luymes J, Weir MJ, Kodama R, Tariq N (2000) Mechanical percussion inversion can result in relocation of lower pole stone fragments after shock wave lithotripsy. Urology 55(2):204\u2013206. https:\/\/doi.org\/10.1016\/s0090-4295(99)00527-0","journal-title":"Urology"},{"issue":"6","key":"6656_CR21","doi-asserted-by":"publisher","first-page":"1096","DOI":"10.1016\/s0022-5347(17)40196-0","volume":"143","author":"N Brownlee","year":"1990","unstructured":"Brownlee N, Foster M, Griffith DP, Carlton Jr (1990) CE. Controlled inversion therapy: An adjunct to the elimination of gravity-dependent fragments following extracorporeal shock wave lithotripsy. J UROL 143(6):1096\u20131098. https:\/\/doi.org\/10.1016\/s0022-5347(17)40196-0","journal-title":"J UROL"}],"container-title":["World Journal of Urology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00345-026-06656-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00345-026-06656-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00345-026-06656-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:00:48Z","timestamp":1786968048000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00345-026-06656-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,17]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["6656"],"URL":"https:\/\/doi.org\/10.1007\/s00345-026-06656-y","relation":{},"ISSN":["1433-8726"],"issn-type":[{"value":"1433-8726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,17]]},"assertion":[{"value":"11 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"579"}}