Knoll T et al, 2011: [Medical and Economic Aspects of Extracorporeal Shock Wave Lithotripsy]
Knoll T, Fritsche HM, Rassweiler J
Urologische Klinik, Klinikum Sindelfingen-Böblingen, Universität Tübingen
Extracorporeal shock wave lithotripsy (ESWL) is the method of choice for most renal and ureteral calculi. However, endoscopic procedures such as ureteroscopy or percutaneous nephrolithotomy are being more and more performed as primary treatment alternatives in clinical routine. This development may result from the sometimes unsatisfying results of ESWL. While this is often explained by a lower efficacy of last-generation machines, an often unrecognized explanation is the impact of a less well trained urologist. To achieve best results it is mandatory that fundamental knowledge about shock wave physics and disintegration mechanisms are available. In Germany, the reimbursement system between outpatient and inpatient departments is totally separate. This leads to difficulties in clinical practice. We believe that patients at risk for complications, such as ureteral stones, urinary tract infections or high age, benefit from inpatient treatment, while uncomplicated renal stones can safely be treated on an outpatient basis. Regular application and training of ESWL will aid an optimization of its results and acceptance.
© Georg Thieme Verlag KG Stuttgart ˙ New York
Aktuelle Urol. 2011 Nov;42(6):363-7. doi: 10.1055/s-0031-1283805. Epub 2011 Nov 16
PMID:22090371[PubMed - in process]
In this publication in German the authors discuss the role of ESWL in view of the increased popularity and use of endoscopic procedures for stone removal. The cause of this change should be sought in less successful outcome of ESWL. It is emphasized, however, that this is an effect of insufficient understanding and knowledge of shockwave physics and how ESWL needs to be carried out with modern lithotripters. Then importance of the focal size, focus pressure, coupling as
well as the strategy of treatment in terms of shockwave administration is discussed. Compared with the experience from the original lithotripter - Dornier HM3 - it is necessary to pay attention to a number of factors in a way that not previously was necessary.
The bottom-line of this short review is that it is surprising to note an increased interest in invasive stone removal when attempts in other fields of urology (and surgery) aim in direction of as little invasiveness as possible. Despite the enthusiasm for the modern endoscopic technology, it is important to be aware of the efficiency and safety of ESWL when carried out with appropriate devices in an optimal and educated way.