Nielsen TK et al., 2017: Efficacy of commercialised extracorporeal shock wave lithotripsy service: a review of 589 renal stones.
Nielsen TK, Jensen JB.
Department of Urology, Hospitalsenheden Vest, Holstebro, Denmark.
Abstract
BACKGROUND: Extracorporeal 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.
METHODS: During 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.
RESULTS: The 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.
CONCLUSIONS: Commercialised 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.
BMC Urol. 2017 Jul 27;17(1):59. doi: 10.1186/s12894-017-0249-8. FREE ARTICLE
Comments 1
The second good quality Scandinavian ESWL study published in the third quarter of 2017 (Wagenius M, et al. Complications in extracorporeal shockwave lithotripsy: a cohort study. Scand J Urol. 2017 Aug 3:1-7) with good results.
Patients were evaluated by CT before and after ESWL. “Experienced technicians performed all treatment and were assisted by the responsible urologist.” The success rate of 93% was achieved with an average of 1,4 sessions per stone. Only “40 stones (7%) did not respond to ESWL treatment and were treated with RIRS or PNL.
Table 1 signifies a remarkable result: the success rates were independent of the stone location One cause may be a good case selection. But in my opinion more important was the fact that ESWL was the business and the job of the technician. He was supposed to do a good job and he did not have a choice to choose URS or PNL like an Urologist. In other words everybody devoted to his job could very probably achieve the same results. This is the reason to select this publication as my reviewer’s choice.