PDI therapy increases stone-free rates for lower pole stones following ESWL or RIRSPDI Therapy Linked to Higher Stone Clearance After Kidney Surgery

World journal of urology Published August 17, 2026 Study authors: Gimenez Luiz G S, Marchini Giovanni S, Torricelli Fabio C M, Danilovic Alexandre, Batagello Carlos A… PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Consider PDI therapy after ESWL or RIRS for lower pole stones to improve short-term stone-free rates.

This meta-analysis of randomized controlled trials evaluated the efficacy of percussion, diuresis, and inversion (PDI) therapy for patients with lower pole stones (LPS) undergoing extracorporeal shockwave lithotripsy (ESWL) or retrograde intrarenal surgery (RIRS). The analysis included 394 patients to compare PDI against observation as a primary management strategy.

The meta-analysis reported a statistically significant difference in stone-free rate (SFR) between the PDI and observation groups, with an OR of 3.81 (95% CI 2.40, 6.06; p < 0.00001). Secondary outcomes including infundibular-pelvic angle (25.9 vs. 24.8 mm; p = 0.83) and infundibular length (69.1 vs. 69.9 degrees; p = 0.20) showed no significant differences between groups. The overall complication rate was also not significantly different between the PDI and observation cohorts (OR 0.36; 95% CI 0.04, 3.56; p = 0.38).

Clinical application is limited by the short-term nature of the follow-up period, which ranged from 2 weeks to 3 months. While PDI therapy was associated with higher stone-free rates in the short term, no significant differences were observed regarding safety or complication rates. Further long-term data are needed to establish durable outcomes.

Researchers analyzed data from 394 patients with lower pole stones who underwent specific surgical procedures, such as shockwave lithotripsy or retrograde intrarenal surgery. The study looked at the impact of a treatment method called Percussion, Diuresis, and Inversion (PDI) compared to standard observation.

The results showed that patients who received PDI therapy had a significantly higher stone-free rate in the short term. This means more stones were successfully cleared from the lower pole area following their procedures. Other measurements, such as the angle of the kidney structures or the length of certain passages, did not show significant differences between the two groups.

Safety data indicated that there was no significant difference in overall complication rates between those who received PDI and those who did not. However, it is important to note that these findings are based on short-term follow-up periods ranging from two weeks to three months. Because this is a meta-analysis of existing trials, the results show an association rather than a guaranteed outcome for every patient.

What this means for you:

PDI therapy was linked to higher stone clearance rates after surgery, with no significant difference in complications.

Common questions

What is the main benefit of PDI therapy?

The study found that PDI therapy was associated with a significantly higher stone-free rate compared to standard observation. This means patients who received the treatment were more likely to have their stones cleared within a short period of two weeks to three months after surgery.

Is PDI therapy safe for patients with lower pole stones?

The study reported no significant difference in overall complication rates between patients who received PDI therapy and those who did not. No serious complications of Clavien-Dindo grade III or higher were reported in the studies analyzed.

How long do these results last?

The findings are based on short-term follow-up periods ranging from 2 weeks to 3 months. Because the data focuses on this specific timeframe, it is important to discuss long-term outcomes and personal treatment plans with a medical professional.

Study Details

Study typeMeta analysis

Sample sizen = 394

EvidenceLevel 1

Follow-up0.5 mo

PublishedAug 2026

PMID42606615

View Original Abstract ↓

PURPOSE: 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. MATERIALS AND METHODS: 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 ≤ 2-4 mm. Risk of bias was assessed using the Cochrane RoB-2 tool and statistical analysis was performed using Review Manager 5.4.1 (Cochrane Collaboration). RESULTS: 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 mm; p = 0.83) and (69.1 vs. 69.9 degrees; p = 0.20), respectively. The meta-analysis revealed a statistically significant difference in SFR (OR 3.81; 95% CI 2.40, 6.06; p < 0.00001; I²=0%; Fig. 2). Furthermore, there was no significant difference in the overall complication rate between groups (OR 0.36; 95% CI 0.04, 3.56; p = 0.38; I²=0%; Fig. 3). No study reported complications of Clavien-Dindo grade III or higher. CONCLUSIONS: 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.

PDI therapy increases stone-free rates for lower pole stones following ESWL or RIRSPDI Therapy Linked to Higher Stone Clearance After Kidney Surgery

Common questions

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PDI therapy increases stone-free rates for lower pole stones following ESWL or RIRSPDI Therapy Linked to Higher Stone Clearance After Kidney Surgery

Common questions

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