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Lantz AG et al, 2016: Shockwave lithotripsy practice pattern variations amongst and between American and Canadian urologists: in support of guidelines.

Lantz AG, McKay JP, Ordon M, Pace K, Monga M, Honey RJ.
Department of Urology, Dalhousie University , Halifax, Nova Scotia, Canada .
Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto , Canada .
Department of Urology, Cleveland Clinic , Cleveland, Ohio.

Abstract

Purpose Shockwave lithotripsy (SWL) is a widely utilized form of treatment for urolithiasis. There are new evidence-based recommendations regarding pre-SWL patient work-up and the performance of SWL. The purpose of this study is to determine practice patterns for SWL and to determine if regional variation exists between Canada and the USA. Materials and Methods A 19-question survey was prepared. Canadian urologists were surveyed through email correspondence. In the USA, members of the Endourological Society and members of two large stone management groups were surveyed. Canadian and American results were compared using the Chi square and Fisher's exact test. Results 94 Canadian urologists and 187 US urologists completed the survey. Practice patterns varied between countries. Intravenous sedation was more commonly used in Canada (CAN 94.7% vs. USA 17.9%, p<0.001), routine antibiotics were more commonly given in USA (CAN 2.1% vs. USA 78.1%, p<0.001); a shock rate of 2Hz was more common in Canada (CAN 76.6% vs. USA 16.2%, p<0.00001); rate of discontinuing ASA for renal and ureteral stone treatment was higher in the USA (renal CAN 88.3% vs. USA 95.7%, p<0.02; ureteral CAN 62.4% vs. 90.3%, p<0.0001); and ureteral stents were more commonly used if treating a large stone or patients with solitary kidneys in the USA (large stones CAN 58.2% vs. USA 88.8%, p=0.0001; solitary kidney CAN 50.6% vs. 66.3%, p=0.02). Conclusions This study highlights the lack of standardization of SWL. Significant regional differences exist in practice patterns and performance of SWL between Canadian and American urologists. 

J Endourol. 2016 Jun 1. [Epub ahead of print]

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Comments 1

Peter Alken on Wednesday, 21 September 2016 14:49

Shocking! Just as the paper by Sharma NL, Alexander CE, Grout E, Turney BW. Shock-wave lithotripsy: variance within UK practice.
No wonder that ESWL loses against PNL and URS. If any of the stone treatment procedures could be standardized than it is ESWL. It is only operator dependent if the operator disinterested.
The abstract gives all the important information. Very probably there are many different ways ESWL is done worldwide and best practice guidelines based on results are lacking. Somebody should pay money to the authors to go on and also report on the treatment results and complications of the patients treated.
The other option to generate best practice guidelines would be to analyse those papers with the best outcome from the literature and distil the core information on success.

Shocking! Just as the paper by Sharma NL, Alexander CE, Grout E, Turney BW. Shock-wave lithotripsy: variance within UK practice. No wonder that ESWL loses against PNL and URS. If any of the stone treatment procedures could be standardized than it is ESWL. It is only operator dependent if the operator disinterested. The abstract gives all the important information. Very probably there are many different ways ESWL is done worldwide and best practice guidelines based on results are lacking. Somebody should pay money to the authors to go on and also report on the treatment results and complications of the patients treated. The other option to generate best practice guidelines would be to analyse those papers with the best outcome from the literature and distil the core information on success.
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