Okada A et al, 2013: Impact of official technical training for urologists on the efficacy of shock wave lithotripsy
Okada A, Yasui T, Taguchi K, Niimi K, Hirose Y, Hamamoto S, Ando R, Kubota Y, Umemoto Y, Tozawa K, Sasaki S, Hayashi Y, Kohri K
Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan
To evaluate the efficacy of company-initiated training of urologists on shock wave lithotripsy (SWL) treatment results, we retrospectively assessed 602 patients who underwent SWL in Nagoya City University Hospital between January 2004 and June 2011 using Lithotripter S (Dornier MedTech, Japan). Training-provided by a training specialist of the company in June 2010-focused on the targeting of renal and proximal ureter stones with a combination of radiography and ultrasonography (US). The stretcher wedges were positioned in the semi-prone position or the semi-supine position for middle and distal ureter stones, respectively. Success rates between 519 pre-training treatments and 83 post-training treatments were compared. Patient age and stone location, burden, number, and composition did not significantly differ between pre- and post-training. Training improved the overall success rate from 66.3 to 87.2 % (P < 0.0001). The mean number of SWL treatments decreased from 1.8 ± 1.8 to 1.4 ± 1.3 (P = 0.01). The first SWL treatment success rate increased from 67.1 to 83.7 % (P = 0.002), and the need for multiple treatments decreased. The frequency of detection of renal and proximal ureter stones by both radiography and US increased from 10.5 % before training to 58.2 % after training (P < 0.0001). Significant factors for successful SWL were determined to be training and prone position for distal ureter stones by multivariate analysis and ultrasonic detection for renal and proximal ureter stones by univariate analysis. Skills in targeting stones using ultrasonography and selecting the proper therapeutic position are essential for improving the success rate of stone removal.
Urolithiasis. 2013 Nov;41(6):487-92. doi: 10.1007/s00240-013-0586-3. Epub 2013 Jul 3
PMID:23821184 [PubMed - in process]
Hans-Göran Tiselius commented the publication of Kumar A et al. in this review series (Kumar A et al.: A Prospective Randomized Comparison Between Shockwave Lithotripsy and Semirigid Ureteroscopy for Upper Ureteral Stones cles that otherwise contribute to inferior disintegration and need of repeated sessions. It is a common misconception that whereas the outcome of URS depends on the operator, that of SWL entirely depends on the lithotripter. This view, unfortunately, is wrong and without appropriate attention to basic principles of SWL there is a high risk that even technical improvements of SWL will have only small effects on SWL-success."
The paper by Okada A et al. is the proof for his statement and documents what everybody suspects but only a few realize and change. The shock wave machine is a device that requires knowledge, training and experience. Without these prerequisites bad results and bad reputation of the technique are only to blame on the users. A SWL license and a license renewal at least for internal use could improve the success rate by 20%!