Nishal Patel et al., 2024: Extracorporeal shock wave lithotripsy: Prematurely falling out of favour? A 7 year retrospective study from an Australian high-volume centre
Nishal Patel 1 2 , Brittany Stephenson-Smith 1 , Jay Roberts 3 , Akshay Kothari 1
1Department of Urology The Prince Charles Hospital Brisbane Queensland Australia.
2Faculty of Medicine The University of Queensland Brisbane Queensland Australia.
3Department of Urology Royal Brisbane and Women's Hospital Brisbane Queensland Australia.
Abstract
Objectives: The aim of this study is to audit 7 years of data with a 3 year follow up from a high-volume stone centre performing extracorporeal shock wave lithotripsy (ESWL) to evaluate efficacy in stone clearance compared to existing knowledge and understand reasons for this performance.
Methods: Patients who received ESWL treatment for renal or proximal ureteric stones at a single centre between January 2012 and January 2019 (to allow minimum 3 year follow up) were retrieved. A retrospective analysis was performed cross referencing for stone size, location, treatment and need for further procedures. Ethical approval was granted through Metro North HHS HREC, Queensland, Australia.
Results: A total of 1930 patients met inclusion criteria. Fifty-seven percent (n = 1100) underwent left-sided ESWL, compared to 43% (n = 830) on the right. Stone size and location were both statistically significant to treatment outcome. Small stones (<1 cm) had an overall clearance rate of 81.9%, medium stones (1-2 cm) had a clearance rate of 60.6% and stones (>2 cm) had a clearance rate of 31.3%. Small stones in an upper calyx had the highest clearance rate (87.5%, n = 120). Allowing for two procedures, 89% of stones were treated successfully.
Conclusion: ESWL remains a legitimate option for the treatment of small and medium sized renal calculi. ESWL stone clearance rates at our centre are higher than published elsewhere and serve as proof to its efficacy. X-ray imaging on the day of the procedure, heavy consultant input and frequent intra-operative imaging are cited as key reasons for success. Further research is warranted to elucidate factors affecting stone clearance rate and to enable more standardised outcomes. Further investment may be required into ESWL provisions in most Australian states and especially in Queensland to enable its continued use in contrast to developing endourological techniques.
BJUI Compass. 2023 Dec 2;5(4):460-465. doi: 10.1002/bco2.314. eCollection 2024 Apr.
PMID: 38633834 PMCID: PMC11019251
Comments 1
These days it is unusual to read reports that express a positive attitude to SWL. The current article is an exception.
The authors included patients in a consequent way, excluding only those who had specific reasons for not being treated with SWL.
Although stone-clearance varied with stone size it is of interest to note that when two sessions were allowed within 3 years, as many as 89% (!) of the stones were successfully treated.
It is difficult to know to which extent the use of general anesthesia and insertion of stents for stones > 15 mm has affected the result, but almost certainly treatment was continued without any attention taken to the patients’ reaction. That is, however, commonly the case when patients are treated without analgesics or with mild analgesics only.
As expected, more complications were recorded for large stones, but the overall complication rate was not more than 9%.
The consequent use of SWL most certainly increases patients’ quality of life and moreover, decreases the cost despite use of anesthesia.
It needs to be emphasized that during a period of steadily increasing enthusiasm for endoscopic stone surgery, SWL is a viable alternative for stones up to 20 mm at a high-volume center.
Urologists who have doubts on the future of SWL are recommended to read this Australian publication!
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