Stone-free rates after extracorporeal shock wave lithotripsy with or without adjunctive external physical vibration lithecbole for upper ureteric stones: a retrospective cohort study

Upper ureteric stones are a prevalent urological challenge, and while extracorporeal shock wave lithotripsy (ESWL) is a standard non-invasive treatment, its efficacy can be limited by residual fragments. This study aimed to evaluate whether combining ESWL with external physical vibration lithecbole (EPVL) improves stone-free rates (SFRs) and renal functional outcomes. A retrospective analysis was conducted on patients with upper ureteric stones treated at our hospital from March 2022 to June 2023. Patients were divided into those receiving ESWL alone and those receiving ESWL combined with EPVL. SFRs were assessed at 1, 2, and 4 weeks post-treatment. Secondary outcomes included auxiliary treatment rates, complications, and renal function indicators (serum β2-microglobulin, cystatin C, and neutrophil gelatinase-associated lipocalin [NGAL]) measured preoperatively and on postoperative day 7. A total of 275 patients were included, with 122 receiving ESWL alone and 153 receiving ESWL combined with EPVL. The combination group demonstrated significantly higher SFRs at both the 2nd week (81.05% vs. 68.03%, P = 0.013) and 4th week (90.85% vs. 77.05%, P = 0.002). Auxiliary treatment rates were significantly lower in the combination group for both secondary ESWL (5.23% vs. 14.75%, P = 0.007) and flexible ureteroscopy (2.61% vs. 8.20%, P = 0.036). After adjusting for preoperative values, postoperative day-7 renal function markers, particularly NGAL, were significantly better in the combination group (adjusted mean difference = − 9.42 μg/L, P = 0.012), with no significant differences in complications. The integration of EPVL with ESWL was associated with significantly higher SFRs and a reduced need for secondary interventions, and with a smaller postoperative rise in renal tubular injury markers; however, the clinical significance of these biomarker differences remains uncertain. These findings suggest a potential benefit of the combined approach; however, given the retrospective design, confirmation in prospective randomized trials is warranted.