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"Baground: the optimal management of lower calyceal stones is still controversial, because no single method is suitable for the removal of all lower calyceal stones. Minimally invasive procedures such as extracorporeal shock wave lithotrispy (ESWL), percutaneous nephrolithotomy (PNCL) and flexible ureteroscopy (fURS) are the therapautic methods for lower calyceal stones. the aim of this study was to identify the optimal management of 10-20 mm lower pole stones. Methods : a meta-analysis of cohort studies published before July 2016 was performed from Medline and Cochrane databases. Management of 10-20 mm lower pole stone treated by fURS, ESWL and PCNL with follow-up of residual stones in 1-3 months after procedure were include and urinary stone in other location and size were exclude. A fixed-effects model with Mantzel-Haenzel method was used to calculate the I2 statistic. All analyses were performed with review manager 5.3. Result : we analized 8 cohort studies. The stone free rate from 958 patient (271 PCNL, 174 fURS and 513 ESWL), 3 months after operation, was 90.8% (246/271) after PCNL; 75.3% (131/174) after fURS; and 64.7% (332/513)after ESWL. Base on stone free rate in 10-20 mm lower pole stone following management, PCNL is better than fURS (overall RR was 1.32 (95% CI 1.13-1.55) ; p<0.001 and I2=57%) and ESWL (overall risk ratio 1.42 (95% CI.30-1.55); p=<0.001 and I2=85%). But if we compare between fURS and ESWL, fURS is better than ESWL base on stone free rate in 10-20 mm lower pole stone management with overall RR 1.16 (95% CI 1.04-1.30; p=0.01 and I2=40%). Conclusion: percutaneous nephrolithotomy provided a higher stone free rate than fURS and ESWL. This meta-analysis may help urologist in makin decision of intervention in 10-20mm lower pole stone management."

"Sebelum ditemukannya alat-alat canggih, pengobatan penyakit batu saluran kemih, khususnya batu ureter, adalah dengan cara operasi terbuka (invasif). Namun saat ini pengobatan yang bersifat invasif mulai ditinggalkan, dan beralih ke cara pengobatan yang minimal invasif, bahkan non invasif.Saat ini, di RSUPN-CM Jakarta, telah tersedia alat untuk mengobati penyakit batu saluran kemih, khususnya batu ureter distal, yang bersifat minimal invasif, yaitu Ureterorenoskop, dan yang bersifat non invasif, yaitu Extracorporeal Shock Wave Lithotripsy (ESWL). Cara pengobatan batu ureter dengan menggunakan alat Ureterorenoskop, disebut tindakan Ureteroskopi (URS).Tujuan dari penelitian ini adalah, untuk mengetahui efektivitas biaya dari pengobatan batu ureter distal, antara yang menggunakan cara URS dengan cara ESWL. Penelitian ini bersifat deskriptif, menggunakan data sekunder subbagian urologi swadana RSUPN-CM, tahun 2001 periode Juni s/d Desember. Analisis data biaya investasi menggunakan biaya investasi setahun. Analisis biaya menggunakan metode Activity Based Costing (ABC), karena metode ini yang paling cocok untuk menganalisis biaya dalam mengobati penyakit batu ureter distal yang merupakan salah satu jenis kegiatan yang ada di subbagian urologi yang memiliki berbagai jenis kegiatan.Hasil dari penelitian ini menunjukkan bahwa, pengobatan batu ureter distal yang paling efektif biaya adalah dengan cara ESWL. Bahkan tindakan ESWL kelas super VIP masih lebih efektif biaya dibandingkan dengan tindakan URS dengan ruang perawatan kelas III. ......An Effectiveness Analysis of Distal Urethral Stones Treatment Compared with Ureterorenoskop and Extracorporeal Shock Wave Lithotripsy at RSUPN-CM Jakarta, 2001Before sophisticated-medical equipment was discovered, invasive surgery was used for Urinary Tract Stone treatments; especially urethral stone. Today, invasive surgery has been no longer implemented, and shifting into minimal or non invasive treatment.RSUPN-CM Jakarta, has two different medical equipments to treat Urinary Tract Stone patient which are Ureterorenoscop for minimal invasive treatment and Extracorporeal Shock Wave Lithotripsy (ESWL) for non invasive treatment. The treatment using Ureterorenoscop is called Ureteroscopy (URS).The aim of this research is to examine and compare the cost effectiveness of urethral distal stone treatment using both equipments. This research is descriptive, using secondary data from subbagian urologi RSUPN-CM in the period of June-December 2001. Meanwhile, data analysis for investment cost is considered in annual base.The analysis of this study is using Activity Based Costing (ABC) method. This method is the most appropriate method for urethral distal stone treatment since subbagian urologi comprises a broad range of interrelated activities. ABC method, therefore, will evaluate the cost of effectiveness for both URS and ESWL.The study shows that ESWL is the most effective cost compared to URS. Even, Super VIP using ESWL is more effective than class III URS."

"Tujuan penelitian ini adalah untuk mengetahui manfaat terapi perkusi mekanik inversi pada penderita batu kaliks inferior ginjal pasca ESWL.Suatu uji klinis terkontrol dilakukan terhadap 40 penderita batu kaliks inferior ginjal yang menjalani terapi Extra Corporeal Shock Wave Lithotripsy (ESWL) di RSCM Jakarta dan masih terdapat sisa batu dengan ukuran 4 mm, antara bulan Desember 2002 hingga Desember 2003. Secara acak, penderita penelitian dimasukkan ke dalam kelompok terapi (dilakukan terapi perkusi mekanik inversi) dan kelompok non terapi (tidak dilakukan terapi perkusi mekanik inversi). Keberhasilan terapi ditentukan dengan adanya pergerakkan fragmen batu dan keadaan bebas batu yang dapat dilihat pada pemeriksaan foto polos abdomen. Uji kemaknaan menggunakan Pearson Chi Square cross tabulation dengan nilai p < 0,05 dianggap bermakna.Hasil penelitian menunjukkan dari 20 orang kelompok terapi, 14 orang (70%) terjadi pergerakkan fragmen batu dan tercapai keadaan bebas batu segera setelah terapi dilakukan, sedangkan 6 orang (30%) tidak terjadi pergerakkan fragmen batu, sedangkan dari 20 orang kelompok non terapi, 13 orang (65%) terjadi keadaan bebas batu dan 7 orang (35%) tidak terjadi keadaan bebas batu, sehingga secara statistik hal ini tidak bermakna (p>0,05). Penelitian ini jugs menunjukkan dari 20 orang kelompok terapi terdapat 13 ()rang (65%) mempunyai ukuran sisa batu 2-4 mm dan 1 prang (5%) dengan ukuran sisa batu 1-2 mm sedangkan pada 20 prang kelompok non terapi terdapat 7 orang (35%) mempunyai ukuran sisa batu 2-4 mm dan 6 prang (30°Io) dengan ukuran sisa batu 1-2 mm yang mencapai keadaan bebas batu, secara statistik hal ini tidak terdapat hubungan bermakna (p . 0,05).Dari penelitian ini dapat disimpulkan baik dilakukan atau tidak dilakukan terapi perkusi mekanik inversi, keduanya dapat mencapai keadaan bebas batu pada penanganan batu kaliks inferior ginjal pasca ESWL, sedangkan ukuran sisa batu pasca ESWL tidak mempengaruhi keadaan bebas batu.

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The purpose of this study is to know the benefit of mechanical inversion therapy for lower pole kidney stone after shock wave lithotripsy in Cipto Mangunkusumo hospital.

A clinical control trial has been done to 40 patients with stone in the lower pole of the kidney who had undergone ESWL treatment with residual stone less than 4 mm in CiptoMangunkusumo hospital between December 2002 to December 2003. Randomly the patients were divided into 2 groups, one of which is with mechanical percussion inversion therapy and the other is without. Successful treatment is based on stone fragment movement and stone free condition which were examined by KUB photos. Pearson chi square tabulation probability test is used with p value less than 0,05 is considered significant.

The result showed that from 20 patients with mechanical percussion inversion therapy, 14 patients (70%) had stone free condition as soon as the treatment done, on the contrast 6 patients (30%) did not have stone fragment movement, whereas from 20 patients without treatment, 13 patients (65%) had stone free condition and 7 patients (35%) did not, so statistically this was not significant (p>0,05). This study also showed that from 20 patients with MPI therapy, 13 patients (65°Io) with residual stone of 2-4 mm and 1 patient (5%) with residual stone of 1-2 mm achieved stone free condition, whereas from control group, there were 7 patients (350/s) with residual stone of 2-4 mm and 6 patients (30%) who had residual stone of 1-2 mm achieved stone free condition. Statistically, this was also not significant (p>0,05).

In conclusion, our study revealed that stone free condition could happen with or without mechanical percussion inversion therapy for lower pole kidney stone after ESWL and the residual stone size after ESWL was not correlated with stone free rate.

Keywords: mechanical percussion inversion therapy, shock wave lithotripsy, lower pole kidney stone"