Lithotripsy Service Research Articles

Transitioning from a mobile to on-site extracorporeal shockwave lithotripsy service: Is it worth it?

Objectives: The aim of this study was to compare the efficiency and effectiveness of a previous mobile versus current on-site lithotripsy service at a tertiary referral centre. Methods: Patient demographics, stone properties and service provision data were collected; retrospectively for mobile extracorporeal shockwave lithotripsy service (mESWL) between December 2017 and December 2018, and prospectively for on-site extracorporeal shockwave lithotripsy service (osESWL) between March 2019 and March 2020. Results: The overall stone clearance rate for mESWL was 57.1% (68/119) and 79.2% (164/207) for osESWL ( p < 0.01). The overall osESWL ureteric stone clearance was 86.5% (77/89). The renal stone clearance rate with osESWL was greater than mESWL; 73.7% (87/118) versus 55.9% (62/111), p < 0.01. Waiting time for osESWL treatment to renal calculi was significantly lower than mESWL (35 versus 47 days), p < 0.01. To achieve stone clearance, mESWL required a larger proportion (25/111, 22.5%) of additional procedures compared to osESWL (16/118, 13.6%), p = 0.08. There was no significant difference in complication rates with mESWL versus osESWL. Over 5 years, there was a projected cost saving of £627,030 with osESWL compared to £158,660 with mESWL. Conclusion: With increased treatment capacity, higher stone clearance rate and shorter waiting times, the on-site lithotripter delivers a better service compared to a visiting mobile lithotripter. Furthermore, it may cut costs in the long term. Level of evidence: Not applicable.

Optimising our GIRFT acute regional lithotripsy service—Improving efficiency and access for those most likely to benefit

Optimising our GIRFT acute regional lithotripsy service—Improving efficiency and access for those most likely to benefit

662 Establishing an Acute Extracorporeal Lithotripsy Service in The COVID 19 Pandemic

Abstract Introduction In England, 40% of patients who present with urinary tract stones as an emergency are actively managed with a procedure, in the majority a stent. This commits them to an inpatient stay, a general anaesthetic and further surgery at a later date. Extracorporeal Shockwave Lithotripsy (ESWL) offers a promising, outpatient alternative especially during the COVID19 pandemic. With COVID19 limiting our ability to provide urgent stone care, we assessed our institutions compliance with Getting It Right First Time (GIRFT) guidelines- which recommends that 10% of patients with acute stones undergo ESWL. Method The audit comprised of 2 cycles; collecting data on the number patients that were admitted with renal colic over a 3-month period, and the percentage treated with ESWL. The first cycle collected data from February to April 2020, while the second cycle collected data from May 2020 to July 2020. Results The first cycle of the audit revealed that 0 patients were treated with acute ESWL. This required implementation of a referral pathway to Frimley Park Hospital who provided ESWL services. After implementation of a pathway, the 2nd cycle of the audit saw that of 32 patients, 6 patients were referred to Frimley for emergency ESWL (compliance rate: 19%). Conclusions With the implantation of a referral pathway, the percentage of patients that we referred for ESWL rose significantly from 0% to 19%, thereby meeting GIRFT guidelines. This audit re-iterates how the pandemic has shifted the way we provide urgent stone care with emergency ESWL in our local trust

P0709 - Outcomes of a modified Shock Wave Lithotripsy (SWL) service offering multiple sessions and including patients with poor prognostic factors during the Coronavirus pandemic

P0709 - Outcomes of a modified Shock Wave Lithotripsy (SWL) service offering multiple sessions and including patients with poor prognostic factors during the Coronavirus pandemic

How to maximize the efficacy of shockwave lithotripsy.

Since its introduction in the early 1980s, extracorporeal shockwave lithotripsy (ESWL) has proven to be a minimally invasive and efficient procedure for the management of renal calculi. It is currently one of the most recommended treatments for small- and medium-sized stones (<20 mm) in most guidelines internationally. The recent coronavirus disease 2019 (COVID-19) outbreak could lead to a further increase in ESWL use as it avoids a general anesthetic and its potential complications in patients with COVID-19 infection. Most publications exhibit ESWL stone-free rates (SFRs) of 70%-80%; however, this is often not the case in many centers, with multiple factors affecting the efficacy of the intervention. Various stone and patient factors have been shown to influence the ESWL success. Stone position, density and size, skin-to-stone distance, and body-mass index contribute to SFRs. Modifications in the lithotripter design and revisions in the technique have also improved the SFRs over the years, with slower shock rates, power-ramping protocols, combined real-time ultrasound, and fluoroscopy imaging technology, all enhancing the efficacy. The adjuvant use of pharmacological agents, such as alpha-blockers, potassium citrate, and the emerging microbubble technology, has also been investigated and shown promising results. Arguably, the most significant determinant of the success of ESWL in a particular unit is how the lithotripsy service is set up and monitored. Careful patient selection, dedicated personnel, and post-treatment imaging review are essential for the optimization of ESWL. Through an analysis of the published studies, this review aimed to explore the measures that contribute to an effectual lithotripsy service in depth.

Oral 41 - Efficacy of Commercialised Extracorporeal Shock Wave Lithotripsy Service: Comparing Outcomes Of 100 Consecutive Patients To International Outcomes

Oral 41 - Efficacy of Commercialised Extracorporeal Shock Wave Lithotripsy Service: Comparing Outcomes Of 100 Consecutive Patients To International Outcomes

Efficacy of commercialised extracorporeal shock wave lithotripsy service: a review of 589 renal stones

BackgroundExtracorporeal shockwave lithotripsy (ESWL) is the management of choice for renal stones 20 mm or smaller, with a stone clearance rate of up to 89%. The purpose of the present is to investigate the efficacy of a commercialised ESWL service, being performed as an outsourced treatment using a mobile lithotripsy system on an outpatient basis. Furthermore, the study aims to evaluate the risk of needing treatment with an internal ureteral double-J stent (JJ) after ESWL treatment.MethodsDuring an eight-year period, 461 patients with a total of 589 renal stones were treated using a mobile lithotripsy system at a single Danish institution. A commercial company performed all treatments using a Storz Modulith SLK® system. Each stone was prospectively registered according to size, intra renal location and the presence of a JJ at the time of treatment. The number of required ESWL treatments and auxiliary procedures were retrospectively evaluated.ResultsThe success rate after the initial ESWL procedure was 69%, which increased to an overall success rate of 93% after repeated treatment. A negative correlation was found between stone size and the overall success rate (r = −0.2, p < 0.01). The upper calyx was associated with a significantly better success rate, but otherwise intra renal stone location was not predictive for treatment success. A total of 17 patients (2.9%) required treatment with a JJ after the ESWL procedure. No significant difference was observed between the stone size or intra renal location and the risk of needing treatment with JJ after ESWL.ConclusionsCommercialised ESWL treatment can achieve an overall success rate of more than 90% using a mobile lithotripsy system. As expected, an inverse relation between stone size and success rate was found. Patients who do not require treatment with a JJ prior to ESWL will only rarely need treatment with a JJ after ESWL, irrespective of stone size and intra renal stone location.

Who "apparently" more spends, "in reality" spends less. Spending "a little" more for the rental of the extracorporeal lithotripter can save "a lot" about the days of hospitalization for urinary stones.

The right to health (according to the Article 32 of the Italian Republic Constitution) is financially conditioned; for this reason the National Health System (NHS) has the objective of rationalize health expenditure according to the criteria of efficiency, effectiveness and economy. This paper is an example of rationalization concerning the extracorporeal shock wave lithotripsy (ESWL). Hospital admissions for urinary stones were taken into account. "Edotto", the database of the Puglia region has identified 23 inpatient admissions during which was performed ESWL. A single operator performed ESWLs with a Storz lithotripter, Modulith SLK. The average hospital stay is conditioned by days "to wait" lithotripsy. In 2014 the hospitalization days "waiting for" lithotripsy were 100. The results were subjected to SWOT analysis and discussed with the Boston Consulting Group Matrix. Constant availability of the lithotripter would spare 100 days of hospitalization, amounting to € 88,200.00. This waste of resources corresponds to an additional cost equal to 98.3% on the cost for the rental of the lithotripter. Instead, reducing "unnecessary" hospitalization days would get a saving of 79.3% on the rental cost. It is as if for 46 days of the lithotripter rent were paid 46 days, while for 365 days of the lithotripter rent were paid only 11.8 sessions per year. Rationalization of resources is not necessarily a synonym of "reduction" of resources, but of reduction of waste in the NHS. A good plan is the most important rational basis to get more resources. About the process taken into account it is seen as an investment of € 21,450.00 would keep unchanged the effectiveness of lithotripsy service but would add efficiency and economy (increase of sessions/year, increase in the active mobility, increase in orthopedic treatments) and would drastically reduce the number hospital days (a waste).

Ureteroscopy and Lithotripsy service in Patan Hospital

Introduction: With advent of URSL (ureterorenoscopy and lithotripsy) and other minimally invasive technique viz; SWL (shock wave lithotripsy), PCNL (percutaneous nephrolithotomy), the urinary stones management has taken a giant leap to serve mankind. The aim of this study is to review a wide series of ureteral stones in which ureteroscopy combined with endoscopic lithotripsy was chosen as the first approach for the treatment of ureteral calculi and to study its diagnostic efficacy.&#x0D; Methods: This is a retrospective study that was carried out in Patan Hospital from Feburary 2010 to Jan 2013. In all cases preoperatively intravenous urography, and a plain film of the urinary tract was taken before the procedure. The operations were carried out with the patient under general anesthesia. Rigid ureteroscopes and the pneumatic lithotripter were used. The fragments were extracted with forceps or baskets assisted with saline flush.&#x0D; Results: We analyzed the result of URSL done in our hospital for variety of urology problem. We found age group 20-40, being the most common group to develop urinary calculus. Most of our patient had single stone of size &gt;5mm. Upper ureter, mid ureter and distal ureter comprises of 4, 30 and 56 stone respectively. Our success rate of URS insertion is 96%(96/100) with complete stone fragmentation with expulsion of the fragments occurred in 97.8%(88/90). Our major perioperative complication were 3% without mortality.&#x0D; Conclusion: URS is useful for diagnostic purpose &amp; URSL is safe and treatment of choice for mid and lower ureteic calculus

Obtaining patient feedback in an outpatient lithotripsy service is facilitated by use of a touch-screen tablet (iPad™) survey.

There is now a requirement for every doctor in the UK to obtain patient feedback for revalidation. This can be an onerous and time-consuming task. The objective of this study was to evaluate a novel electronic patient feedback method in an outpatient lithotripsy service setting. Between September 2013 and January 2014, 100 patients attending an outpatient lithotripsy service in Oxford were asked to complete a selection of pre-approved NHS questions about the service they had received. Questions were presented on a tablet device (iPad™) and answered using the touch screen. Departmental staff were unaware of the questions in the survey. Patients were asked to complete the survey by an independent research nurse. Questions were created online in a free-to-use web-based survey application and presented on the tablet device in a user-friendly format via an application. Data were uploaded via wifi™ to the online system. Data were viewed, automatically analysed and displayed graphically. The age range of the patients surveyed was 20-80 years of age. All 100 patients completed the survey without difficulty. All patients answered every question. Data could be automatically viewed, analysed and presented graphically. This method of collecting patient feedback proved to be rapid and efficient. The feedback highlighted a high patient satisfaction with the lithotripsy service. A touch screen tablet device is an efficient and effective method of collecting truly objective patient feedback. This method of patient feedback could be employed in other clinical environments to collect data for revalidation purposes.

Efficacy of a mobile lithotripsy service: A one-year review of 222 patients

Objective. Extracorporeal shockwave lithotripsy (ESWL) is the management of choice for ureteric and renal stones 20 mm or smaller, with a stone clearance rate of up to 89%. This study determined whether such a high success rate could apply to centres using mobile ESWL, by reviewing the performance at one centre that provides such a service. Material and methods. Between July 2011 and July 2012, 222 patients (median age 51 years, range 18–90 years) underwent one to five sessions of ESWL for ureteric and renal stones (mean size 15 mm, range 4–22 mm). Stone clearance was regarded as residual fragments 2 mm or smaller after completion of sessions. Results. In total, 110 out of 222 patients (49%) were clear of stones. Stones were radiopaque in 198 (89%) and radiolucent in 24 patients (11%), with clearance rates of 48% and 63%, respectively. Regarding size, 36 (16%) were 1–5 mm, 144 (65%) 5–10 mm, 28 (12%) 10–15 mm, eight (4%) 15–20 mm and six (3%) larger than 20 mm, with clearance rates of 61%, 55%, 18%, 13% and 50%, respectively. In total, 173 (78%) were renal stones and 49 (22%) ureteric, with respective clearance rates of 49% and 51%. For kidney stones, 15 (9%) were in the upper, 32 (18%) in the mid, 75 (43%) in the lower pole and 51 (30%) in the pelvis, with clearance rates of 52%, 59%, 49% and 41%; for ureteric stones, 32 (65%) were in the upper, 10 (20%) in the mid and seven (15%) in the lower ureter, with clearance rates of 47%, 70% and 43%, respectively. Conclusion. The performance of mobile ESWL was significantly poorer than expected, and this may be related to a lack of clinical ownership. The authors believe that such a service should be permanently placed on site.

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

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.

Emergency shock wave lithotripsy for ureteric stones

Extracorporeal shock wave lithotripsy has been used for over 2 decades, but its application in the acute setting remains under review. With continuing refinements to the technology, it is timely to review its efficacy in the emergency setting. The procedure has an overall low morbidity and is generally well tolerated. Success rates of 70-80% are reported in a number of studies, with relatively low complication rates. Although much attention has been given to the improvements in the outcome of ureteroscopic stone clearance, the benefits of a noninvasive procedure which does not require general anaesthesia may be appealing and indeed preferable for many patients. This should remain a valid alternative treatment option offered to patients, and its provision may be restricted by resource availability rather than clinical evidence. Centres should be identified that can offer an emergency extracorporeal shock wave lithotripsy service and patients informed of outcome data from such centres.

Análise do impacto do progresso tecnológico nos custos do tratamento hospitalar: o caso do tratamento para litíase urinária no Hospital Universitário de Brasília

O progresso tecnológico na área de saúde tem provocado a elevação dos custos da assistência médica, preocupando a população mundial, os agentes privados e os responsáveis pelas políticas públicas. Estetrabalho apresenta uma análise do impacto do progresso tecnológico - delimitado, neste estudo, à incorporação de equipamentos médicos - nos custos do tratamento hospitalar. Para cumprir o objetivo, foram escolhidos ostratamentos médicos para litíase urinária - litotripsia e cirurgia - devido ao histórico de relevantes avanços tecnológicos. O estudo de caso foi realizado no Serviço de Litotripsia e no Centro Cirúrgico do Hospital Universitário de Brasília (HUB), no período de 2001 a 2003. Foram comparados os custos e as receitas diferenciais das alternativas de tratamento para calculose urinária em quatro opções de decisão. Para testar a robustez dos resultados, foi incorporada a variável incerteza, por meio de simulações no sistema Crystall Ball, realizando 50.000 iterações. Os principais impactos do progresso tecnológico nos custos do tratamento paralitíase urinária são: aumento da capacidade instalada, geração de despesa com obsolescência e aumento das receitas.

Re-auditing a regional lithotripsy service.

To assess, in a repeat audit of a regional lithotripsy service, whether changes implemented after a regional audit in 1994 (which showed disappointing results from shock wave lithotripsy, attributable to both poor patient selection and an inadequate fixed-site lithotripter) have had any effect. A data-collection sheet was devised to gather information on the site, size and number of stones treated, together with information on the lithotripsy treatment and outcome. Patients selected for the audit were the first 50 new patients treated with lithotripsy at each centre in 1999. As only one hospital has a fixed-site lithotripsy machine, the results of mobile lithotripsy were grouped by machine for analysis. There was an overall improvement in patient selection from the previous audits. Few stones of > 16 mm or < 4 mm were treated. Two units treated more ureteric stones, thought to reflect first the influence of a fixed-site lithotripter, and second a willingness to insert a ureteric stent and await the next mobile lithotripter visit. The stone free rates were all disappointingly low (16.7-26.7%) but the results improved when fragments of < 4 mm were included as "successful" giving an "overall success rate" of 45.9-66.7%. The unit with a fixed-site lithotripter appeared to perform better (two-thirds successful) than the mobile machines (Modulith SLX, 51%; Modulith SLK, 46%). One centre visited by both mobile machines had a success rate of 65% but a high rate of auxiliary procedures (35% vs 16-19% vs the fixed-site). Although these results show some improvement in patient selection for our regional lithotripsy service, stone-free and success rates are poorer than those reported elsewhere. This may reflect the modern lithotripsy machines that allow day-case treatment with minimal analgesia, and confirms reports by other authors who encourage a re-examination of success rates of shock wave lithotripsy.

Risk Factors Predisposing to Repeated Extracorporeal Shockwave Lithotripsy

The Victorian Lithotripsy Service is geographically unique, representing the only Australian lithotripter for a 900-km radius and serving a patient population of over 3 million, and 26 accredited operator urologists. Because of distance and health service constraints few patients treated for renal calculi on this machine have the opportunity to seek additional treatment by extracorporeal shockwave lithotripsy (ESWL) elsewhere. The treatment histories of all patients who underwent ESWL at this center over a 4-year period were examined, with those patients who required ESWL on more than one occasion being identified and their treatment details reviewed. The retreatment rate was approximately 6%. In patients who required three or more ESWL treatments multiple calculi were present significantly more often than in the overall cohort (p < 0.05), and ESWL alone was ultimately successful in obtaining satisfactory stone fragmentation in only 62% of this group. In view of the high cost of repeated treatments by ESWL the applicability of this treatment method in cases of multiple calculi should be questioned. Initial undertreatment of calculi may also represent a significant factor in the retreatment of some radiopaque calculi.

Experience with the pulsed dye laser in management of ureteric calculi.

Pulsed dye laser lithotripsy is a recently developed technique for the management of urinary calculi. This article reports the results of treatment of a cohort of patients managed with this technology. Post-treatment bed stay was generally less than 48 h, narcotic analgesia was not regularly required, and no significant post-treatment complications were encountered. This treatment appeared to complement an existing extracorporeal shockwave lithotripsy (ESWL) service at St Vincent's Hospital and may offer a financial advantage in the treatment of patients with urinary calculi.

Anaesthesia for extracorporeal shockwave lithotripsy at the Victorian Lithotripsy Service--the first 300 patients.

A prospective survey was undertaken of the anaesthesia for the first 300 patients at the Victorian Lithotripsy Service. The majority (71.7%) were not hospitalised on site, including four quadriplegics and two ASA grade IV patients. Two hundred and eighty-three (94.3%) patients received continuous lumbar epidural anaesthesia, sixteen (5.3%) received general anaesthesia and one received a spinal anaesthetic. Eighty-two patients (27.3%) underwent ancillary procedures at the time of extracorporeal shockwave lithotripsy. The most common intraoperative complications were hypotension (72 patients, 25.4%) and shivering (39 patients, 13.8%). Arrhythmias occurred in nine (3%) patients. There was a 90% patient follow-up rate and the most common postoperative complication was backache (101 patients, 37.4%). The problems of anaesthesia for extracorporeal shockwave lithotripsy are discussed. Epidural anaesthesia offers a number of advantages for this procedure and proved very suitable for the majority of patients.

ESWL: Extracorporeal shock wave lithotripsy: tehnical concept, experimental research and clinical application. 2nd rev., enl. edn

Medical Journal of AustraliaVolume 147, Issue 4 p. 196-196 Book Review ESWL: Extracorporeal shock wave lithotripsy: tehnical concept, experimental research and clinical application. 2nd rev., enl. edn James Mortensen, James Mortensen Clinical Supervisor Victorian Lithotripsy Service, 173 Victoria Parade, Fitzroy, VIC, 3065Search for more papers by this author James Mortensen, James Mortensen Clinical Supervisor Victorian Lithotripsy Service, 173 Victoria Parade, Fitzroy, VIC, 3065Search for more papers by this author First published: 01 August 1987 https://doi.org/10.5694/j.1326-5377.1987.tb133365.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume147, Issue4August 1987Pages 196-196 RelatedInformation