1535 SHOCK WAVE LITHOTRIPSY REFERRAL PATTERN CHANGES OVER A DECADE AT A SINGLE CENTRE

Abstract

You have accessJournal of UrologyStone Disease: New Technology/SWL, Ureteroscopic or Percutaneous Stone Removal I1 Apr 20121535 SHOCK WAVE LITHOTRIPSY REFERRAL PATTERN CHANGES OVER A DECADE AT A SINGLE CENTRE Mohamed Elkoushy and Sero Andonian Mohamed ElkoushyMohamed Elkoushy Montreal, Canada More articles by this author and Sero AndonianSero Andonian Montreal, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1304AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Both American and European Urological Associations have revised their guidelines for management of urolithiasis in December 2007. Whereas the 1997 guidelines recommended Shock Wave Lithotripsy (SWL) for proximal ureteral stones < 1cm, the 2007 guidelines indicated that ureteroscopic lithotripsy is an acceptable first-line treatment modality for proximal ureteral stones of any size. However, no data is available about compliance of urologists with these revised guidelines. Therefore, the aim of the present study was to assess the impact of the revised 2007 guidelines on referral patterns for Shock Wave Lithotripsy (SWL) at a single centre. METHODS A retrospective review of prospectively collected SWL database was performed for consecutive patients referred for SWL at a tertiary stone center between December 1999 and December 2010. A total of 7620 SWL treatments were included (3884 from Dec. 1999 till Dec. 2005, 1438 from Jan 2006 till Dec. 2007, and 2298 from Jan 2008 till Dec. 2010). The location of the original stone referred for SWL treatment was used for the present study. Patients referred for retreatment of the same stone or its fragments were excluded. RESULTS Left-sided stones were comparable in all groups (55.5%, 54.7%, and 53.2%, p=0.11). There was no significant difference among the three groups in terms of stone size [mean stone size (95%CI) was 9.5 (8.4- 10.6), 9.0(8.8- 9.2), and 9.7 (9.5-9.8), mm; p=0.37]. In terms of location of stones treated with SWL, the proximal ureteral was the most common location prior to Dec 2005, whereas renal pelvis was the most common location after Jan 2006. There was a small but significant increase in the percentage of upper and mid-calyceal stones (11.7%, 14.1%, and 13.4%; p=0.03). Most importantly, proximal ureteral stones treated with SWL significantly decreased over the study period (24.8%, 20.8%, 18.1%; p=0.006). Likewise, the proximal ureteral stones ≥10 mm were significantly decreased over time (38.6%, 24.7%, 18.9%, p=0.003). CONCLUSIONS There was a trend of decreasing referral of proximal ureteral stones for SWL over the study period. These findings suggests adherence of local urologists to the 2007 EUA/AUA guidelines on management of urolithiasis. Shock Wave Lithotripsy Referral Pattern in The Last Decade Stone location From Dec1999- Dec 2005 From Jan 2006 till Dec 2007 From Jan 2008 till Dec 2010 p-value Upper and mid poles 455(11.7%) 203(14.1%) 308(13.4%) 0.03 Lower pole 785(20.2%) 276(19.2%) 433(18.8%) 0.34 Renal pelvis 889(22.9%) 336(23.4%) 624(27.1) 0.65 Proximal ureter 965(24.8%) 299(20.8%) 417(18.1%) 0.006 Mid ureter 240(6.2%) 102(7.1%) 166(7.2%) 0.82 Distal ureter 550(14.2%) 222(15.4%) 350(15.2%) 0.34 Total 3884 1438 2298 NA © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e621 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Elkoushy Montreal, Canada More articles by this author Sero Andonian Montreal, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...