Reviewer's Choice

Michaël Mel Henderickx et al., 2024: Heavy as a rock or light as dust: a comparison between the perceived workload for extracorporeal shockwave lithotripsy, ureterorenoscopy and percutaneous nephrolithotomy

Thursday, 12 September 2024

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Michaël Mel Henderickx 1 2 , Nora Hendriks 1 2 3 , A Carolien Bouma-Houwert 1 2 , Joyce Baard 1 2 , Guido M Kamphuis 1 2 , Hugo W Schuil 1 2 3 , Harrie P Beerlage 1 , D Martijn de Bruin 1 2 4
1Department of Urology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.
2Amsterdam Endourology Research Group (AERG), Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.
3Department of Urology, Alrijne Hospital, Leiderdorp, the Netherlands.
4Department of Biomedical Engineering & Physics, Amsterdam UMC , University of Amsterdam, Amsterdam, the Netherlands.

Abstract

Introduction: There are three common treatment options for kidney stones: extracorporeal shockwave lithotripsy (ESWL), ureterorenoscopy (URS) and percutaneous nephrolithotomy (PNL). The choice of treatment is based on stone- and patient-related characteristics. However, some stones are eligible for several approaches and the decision is made based on patient and urologist's preferences. This study evaluates which approach has the highest workload.

Material and methods: Between March and August 2022, five members of the Amsterdam Endourology Research Group collected data from 22 ESWL, 31 URS and 22 PNL procedures. After each procedure, the SURG-TLX questionnaire was completed by the surgeon to evaluate workload. Six dimensions were scored for each procedure, including: mental demands, physical demands, temporal demands, task complexity, situational stress, and distractions. The total workload, and the median for each dimension, was calculated and compared for the three treatments.

Results: ESWL scored significantly lower than URS for mental demands, physical demands, temporal demands, situational stress, distraction and total workload. However, task complexity did not differ significantly between the two techniques. Compared with PNL, ESWL scored significantly lower for all dimensions. Finally, PNL received significantly higher scores for mental demands, physical demands, temporal demands, situational stress, distractions and total workload than URS. Only task complexity showed no significant difference between both groups.

Conclusions: Urologists perceive the highest workload during PNL, followed by URS and finally ESWL. A follow-up study is needed to identify stressors that increase perceived workload with the purpose to address these variables and as final objective to improve urologists' workload, patient safety and treatment outcomes.

Cent European J Urol. 2024;77(1):129-135. doi: 10.5173/ceju.2023.214. Epub 2024 Jan 26.
PMID: 38645810 PMCID: PMC11032039 DOI: 10.5173/ceju.2023.214 FREE PMC ARTICLE

Comments 1

Peter Alken on Thursday, 12 September 2024 11:00

A very interesting paper because it looks at stone therapy from a completely different perspective than the usual one.
They analysed data "from consecutive ESWL, URS and PNL procedures". Limitations are that the complexity of the cases, the criteria for selecting a procedure, the surgeon's experience and the results were not assessed. However, this does not detract from the value of the publication. In the present series the ESWL procedures “were performed by participants in the beginning of their endourology career and PNL-procedures were performed by the more experienced members.”
Many different aspects of stone therapy appear. One reason why ESWL scores were so low could have been that the urological novices were not even aware of the complexity of the task – to what effect?:
“Despite the successful achievements with SWL there is presently a trend towards the preferred use of invasive endoscopic procedures rather than a non-invasive approach by means of SWL. This development is an effect of a considerable variation of SWL results. Literature data give stone-free rates for renal and ureteral stones in the range of 32–90 % … and 43–98 %, respectively … There are indeed several explanations for this variation …, since SWL was considered an easy-to-handle technology and by many urologists a boring part of urology, it was either put in the hands of young colleagues without or with only limited treatment instructions … In some cases these arrangements worked out satisfactorily, in others obviously less so. This unfortunate situation undoubtedly explains the variable success reported for SWL.” (1) (2).

1 Tiselius HG, Chaussy CG. Aspects on how extracorporeal shockwave lithotripsy should be carried out in order to be maximally effective. Urol Res. 2012 Oct;40(5):433-46. doi: 10.1007/s00240-012-0485-z. Epub 2012 Jun 27. PMID: 22736393.
2 Chaussy CG, Tiselius HG. How can and should we optimize extracorporeal shockwave lithotripsy? Urolithiasis. 2018 Feb;46(1):3-17. doi: 10.1007/s00240-017-1020-z. Epub 2017 Nov 25. PMID: 29177561; PMCID: PMC5773650.

Peter Alken

A very interesting paper because it looks at stone therapy from a completely different perspective than the usual one. 
They analysed data "from consecutive ESWL, URS and PNL procedures". Limitations are that the complexity of the cases, the criteria for selecting a procedure, the surgeon's experience and the results were not assessed. However, this does not detract from the value of the publication. In the present series the ESWL procedures “were performed by participants in the beginning of their endourology career and PNL-procedures were performed by the more experienced members.”
Many different aspects of stone therapy appear. One reason why ESWL scores were so low could have been that the urological novices were not even aware of the complexity of the task – to what effect?:
“Despite the successful achievements with SWL there is presently a trend towards the preferred use of invasive endoscopic procedures rather than a non-invasive approach by means of SWL. This development is an effect of a considerable variation of SWL results. Literature data give stone-free rates for renal and ureteral stones in the range of 32–90 % … and 43–98 %, respectively … There are indeed several explanations for this variation …, since SWL was considered an easy-to-handle technology and by many urologists a boring part of urology, it was either put in the hands of young colleagues without or with only limited treatment instructions … In some cases these arrangements worked out satisfactorily, in others obviously less so. This unfortunate situation undoubtedly explains the variable success reported for SWL.” (1) (2).

1 Tiselius HG, Chaussy CG. Aspects on how extracorporeal shockwave lithotripsy should be carried out in order to be maximally effective. Urol Res. 2012 Oct;40(5):433-46. doi: 10.1007/s00240-012-0485-z. Epub 2012 Jun 27. PMID: 22736393.
2 Chaussy CG, Tiselius HG. How can and should we optimize extracorporeal shockwave lithotripsy? Urolithiasis. 2018 Feb;46(1):3-17. doi: 10.1007/s00240-017-1020-z. Epub 2017 Nov 25. PMID: 29177561; PMCID: PMC5773650.

Peter Alken

A very interesting paper because it looks at stone therapy from a completely different perspective than the usual one. They analysed data "from consecutive ESWL, URS and PNL procedures". Limitations are that the complexity of the cases, the criteria for selecting a procedure, the surgeon's experience and the results were not assessed. However, this does not detract from the value of the publication. In the present series the ESWL procedures “were performed by participants in the beginning of their endourology career and PNL-procedures were performed by the more experienced members.” Many different aspects of stone therapy appear. One reason why ESWL scores were so low could have been that the urological novices were not even aware of the complexity of the task – to what effect?: “Despite the successful achievements with SWL there is presently a trend towards the preferred use of invasive endoscopic procedures rather than a non-invasive approach by means of SWL. This development is an effect of a considerable variation of SWL results. Literature data give stone-free rates for renal and ureteral stones in the range of 32–90 % … and 43–98 %, respectively … There are indeed several explanations for this variation …, since SWL was considered an easy-to-handle technology and by many urologists a boring part of urology, it was either put in the hands of young colleagues without or with only limited treatment instructions … In some cases these arrangements worked out satisfactorily, in others obviously less so. This unfortunate situation undoubtedly explains the variable success reported for SWL.” (1) (2). 1 Tiselius HG, Chaussy CG. Aspects on how extracorporeal shockwave lithotripsy should be carried out in order to be maximally effective. Urol Res. 2012 Oct;40(5):433-46. doi: 10.1007/s00240-012-0485-z. Epub 2012 Jun 27. PMID: 22736393. 2 Chaussy CG, Tiselius HG. How can and should we optimize extracorporeal shockwave lithotripsy? Urolithiasis. 2018 Feb;46(1):3-17. doi: 10.1007/s00240-017-1020-z. Epub 2017 Nov 25. PMID: 29177561; PMCID: PMC5773650. Peter Alken

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