Editorial comment on “Efficacy of a mobile lithotripsy service: A one-year review of 222 patients”

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This is an interesting and important article that clearly reflects some of the problems of shockwave lithotripsy (SWL) today. The clearly presented results show that successful SWL requires a considerable input that most certainly is difficult to achieve in a mobile lithotripter organization and with treatments carried out entirely by technicians. With full respect to the skill of qualified SWL technicians, there are several treatment variables that need consideration and modification in order to achieve acceptable results. When the responsibility of this technique more or less completely is handed over to technicians and nurses, it stands to reason that the procedure in most or at least in several cases will be carried out it a stereotyped way. When the responsible urologist accordingly has very limited experience of the technique the results will be inferior. It is, for instance, my own experience that effective SWL requires adequate pain relief, and just a small dose of paracetamol and tramadol (if needed!) is probably insufficient. I strongly agree with the authors that the lithotripter service needs to be stationary. But it is also necessary to make certain that the lithotripters are run by operators who can modify the procedure according to the course of the disintegration progress. Moreover, there is a need for strict follow-up routines with the possibility of repeating the SWL if necessary, rather than immediately switching to an invasive solution. If we continue to ignore the many basic principles of SWL an increasing number of patients will be treated with anaesthesiarequiring endoscopic and more expensive procedures.