External mechanical vibration as an adjunct to medical expulsive therapy for distal ureteral stones ≤ 10 mm: a prospective cohort study.

purposeTo evaluate whether externally applied mechanical vibration (an EPVL-based approach) improves stone passage when used as an adjunct to medical expulsive therapy (MET) in patients with distal ureteral stones ≤ 10 mm.

methodsIn this prospective observational cohort study, 697 patients with unilateral distal ureteral stones were stratified by size (≤ 5 mm vs > 5 mm) and managed with observation, tamsulosin-based MET, externally applied mechanical vibration (an EPVL-based approach), or vibration combined with MET. The primary endpoint was cumulative stone passage within 4 weeks. Secondary endpoints included complications (Clavien-Dindo classification) and requirement for ureterorenoscopy (URS).

resultsEPVL-based strategies were associated with higher early stone passage rates in both size groups. In stones ≤ 5 mm, final stone-free rates were high across all strategies (83.3-95.3%; p = 0.081), suggesting a primary effect on time to passage. In stones > 5 mm, week-4 stone-free rates were significantly higher with MET (78.3%), EPVL (81.0%), and EPVL + MET (88.4%) compared with observation (53.9%) (p < 0.001). Complication rates were higher in stones > 5 mm than in ≤ 5 mm (13.7% vs 4.6%; p < 0.001), without significant differences between management strategies.

conclusionExternally applied mechanical vibration may serve as a safe and pragmatic noninvasive adjunct to MET. It was associated with faster stone passage and higher stone-free rates in distal ureteral stones > 5 mm without an apparent increase in complication risk.