Postural Drainage with Percussion to Aid Passage of Kidney Stone Fragments After Lithotripsy

Introduction

Kidney stones can be broken into small fragments through various forms of treatments (e.g. shockwave lithotripsy (SWL) or Laser lithotripsy). Most of the small stone fragments can be passed spontaneously down the ureter. However, stone or stone fragments located in the lower pole of the kidneys have a tendency to stay there; when an individual stands in an upright position gravity pulls these fragments down (Fig. 1).

Figure 1 : Kidney stone stuck in lower pole due to gravity when in an upright standing position

Your doctor may ask you to do Postural Drainage with percussion to aid the passage of the stone fragments. This involves lying down on your side with the hips elevated higher than the chest so the kidney is tilted down. The elevation and percussion (tapping and shaking motion) will help move the stone fragments out of the lower pole into the renal pelvis and the ureter (Fig. 2).
When you stand up, gravity aids the stone fragments to move from the lower pole into the renal pelvis, then into the ureter, and down, allowing it to pass. (Fig. 3) Your doctor may ask you to do Postural Drainage with percussion 2 times a day for several weeks or more.

Postural Drainage has several methods with some methods being more difficult to follow.

Drink ~2 glasses of water (8oz/glass). Wait about 30-45 minutes before engaging in Postural Drainage with percussion. The 30-45 minute wait allows the body to absorb the water and enables more urine to come out of the kidneys.
Put 3 or 4 pillows on your bed. The pillows should be stacked and under the hips. Lie on your side with the side that has the kidney stones facing up (parallel to the ceiling). Your chest should be lower than your hips. (Fig. 4)
Using your hand that is on the same side as the kidney stones, hold the fingers together to form a cup. (Fig. 5) Perform percussions (taps) on the side and back. This motion will be similar to burping a baby. You may ask somebody to perform the percussion on you. Percussion should be done firm enough, but should not hurt you. You should do about 2 sets of 20-30 percussions.
After performing the percussions, you should sit up slowly to avoid getting dizzy. *Drink another 1 to 2 glasses of water to help flush out the stone fragments. It may take time to pass the stone.