Sharma NL et al, 2016: Shock-wave lithotripsy: variance within UK practice.
Sharma NL, Alexander CE, Grout E, Turney BW.
School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK.
Oxford Stone Group, Department of Urology, Nuffield Department of Surgical Sciences, Oxford University Hospitals NHS Trust, Oxford, UK.
The objectives of this study are to determine the current treatment policies of UK shock-wave lithotripsy centres. Fixed-site lithotripter centres in the UK were identified via the national Therapeutic Interventions for Stones of the Ureter (TISU) study (n = 25). Questionnaires were completed regarding current SWL protocols for each centre, including management of anticoagulation, use of antibiotics and analgesia, urine testing, pacemakers, and arterial aneurysms. Data were collected regarding service delivery. Responses were obtained for 21 centres. Most centres use the Storz Modulith (85.7 %). Wide variation was observed in clinical contraindications to SWL, with 47.6 % centres performing SWL in patients with an abdominal aortic aneurysm, 66.7 % performing SWL in patients with a pacemaker, and 66.7 % of centres not performing SWL in asymptomatic patients with a urine dipstick positive for nitrites and leucocytes. The management of anticoagulation pre- and post-SWL showed wide variation, with the omission of anticoagulation ranging from 0 to 10 days pre-SWL. Seventeen distinct analgesia regimens were reported and prophylactic antibiotics are routinely administered in 25.0 % of centres. Tamsulosin is prescribed to all patients in 20.0 % of centres and a further 15.0 % of centres routinely prescribe tamsulosin post-SWL of ureteric stones. The included centres undertake SWL a median of 4 days per week and treat a median of six patients per list. Emergency SWL is unavailable in 30.0 % of centres. This observational real-life study has identified a significant disparity in the delivery of SWL throughout the UK, despite high numbers of patients with renal and ureteric stones being treated with this modality. Further studies should address the key areas of controversy, including an assessment of technical training, and facilitate the development of national guidelines to ensure a high level of standardized care for SWL patients.
Urolithiasis. 2016 May 23. [Epub ahead of print]
Shocking! Just as the paper by Lantz AG, McKay JP, Ordon M, Pace K, Monga M, Honey RJ. Shockwave lithotripsy practice pattern variations amongst and between American and Canadian urologists: in support of guidelines.
There must be differences not only in the quality of care but also in the quality of results.
Why do urologists know so little about what is best for so many of their patients? :
“data from Hospital Episode Statistics (HES) demonstrate a 55 % increase in the number of upper urinary tract stones treated with SWL between 2000 and 2010 in England, with SWL performed almost as frequently as transurethral resection of the prostate (TURP) and transurethral resection of bladder tumours (TURBTs) in 2010” (Turney BW, Reynard JM, Noble JG, Keoghane SR (2011) Trends in urological stone disease. BJU Int 109:1082–1087