The Efficacy and Safety of Physical Therapy Techniques on Stone‐Free Rates Post‐Conventional Renal Stone Surgery

ABSTRACT Persisting small renal stone fragments remain a challenge after conventional renal stone treatment (ESWL or endoscopic treatment). Physical vibration therapy and patient inversion therapy are new techniques developed with the aim of increasing the stone‐free rate (SFR). This study aims to evaluate the efficacy and safety of physical therapy and mechanical percussion in improving SFR after conventional stone surgery. A systematic review meta‐analysis was performed according to the Cochrane Handbook and registered in PROSPERO (CRD42021232954). PubMed, Web of Science, and Scopus databases were searched for manuscripts considering adjunctive stone treatment methods following endoscopic surgery or shock wave lithotripsy, published between 2018 and 2024. Additional inclusion criteria encompassed randomized controlled trials, cohort studies, and case−control studies published in English. Duplicate studies or studies that did not meet the inclusion criteria were excluded. Full manuscripts were reviewed for clinical data. OpenMeta (analyst) was used to perform statistical analysis, and the ROBINS‐I tool was used for risk of bias assessment. Six studies comprising 1026 participants were included. Our study showed that adjuvant therapy (EPVL or PDI) after stone surgery (ESWL or RIRS) significantly increases SFR at 1 week (OR = 0.60, p < 0.001), 2 weeks (OR = 0.689, p < 0.001), and at 4 weeks (OR = 0.786, p < 0.001). Complications did not differ between treatment arms and control groups. The overall risk of bias among studies was low. Adjuvant therapy has been shown to be an effective tool in increasing SFR post‐conventional stone surgery. Further research is necessary to create standardized treatment protocols.