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Brown RD et al, 2014: Best practices in shock wave lithotripsy: a comparison of regional practice patterns.

Brown RD, De S, Sarkissian C, Monga M
Stevan B. Streem Center for Endourology & Stone Disease, Glickman Urological & Kidney Institute, The Cleveland Clinic, Cleveland, OH.

 

Abstract

OBJECTIVE: To evaluate regional differences in adaptation of best practice recommendations for extracorporeal shock wave lithotripsy (SWL) across 4 distinct geographic regions. METHODS: A retrospective study was performed using a prospective database maintained by a
mobile lithotripsy provider (ForTec Medical, Streetsboro, OH). SWL cases performed in Ohio, Northern Illinois/Southern Wisconsin, Florida, and New York were included. Treatment parameters evaluated included treatment rate, use of a power ramp-up protocol, use of a pretreatment pause after the initial 100 shocks, ancillary procedures, and need for retreatment. Regional and physician-specific patterns were examined. Statistical analyses using chi-square and analysis of variance were performed with a significance of P <.05. RESULTS: Data from 2240 SWL
procedures were included in the study. Overall adaptation of power ramp-up protocols and treatment rates were high (93% and 93%), whereas use of pause was lower (75%, P <.001). Retreatment rates were low (4.3%), although ancillary procedures were performed in 34% of patients, and 8.3% of patients received stents for stones <1 cm. Regional differences were present in all parameters: Florida physicians used power ramp-up less (83%, P <.001) but had good use of pretreatment pause (98%, P <.001), both Wisconsin/Illinois and New York were less likely to use slow rate (87% and 84%, respectively, P <.001). CONCLUSION: The recommendations for slower shock wave rates and power ramp protocols have reached high penetration in urologic practices; however, the more recent recommendation for a pause after the initial 100 shocks has been less uniformly implemented. Inconsistencies in regional adaptation of best practices may identify opportunities for further education.

Urology. 2014 May;83(5):1060-4. doi: 10.1016/j.urology.2014.01.017.

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Comments 1

Peter Alken on Tuesday, 26 August 2014 10:20

This is an interesting paper because it shows the real life situation which seems to be very close to the general recommendations. The exceptionally low retreatment rates of 4.3% are not commented and as such difficult to understand. Retreatment rates are not mentioned as primary or secondary study endpoints. Unfortunately there are also no follow up data available.

This is an interesting paper because it shows the real life situation which seems to be very close to the general recommendations. The exceptionally low retreatment rates of 4.3% are not commented and as such difficult to understand. Retreatment rates are not mentioned as primary or secondary study endpoints. Unfortunately there are also no follow up data available.
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