How can and should we optimize extracorporeal shockwave lithotripsy?

Chaussy, C.; Tiselius, Hans‐Göran

doi:10.1007/s00240-017-1020-z

Cited by 48 publications

(41 citation statements)

References 113 publications

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“…Although SWL is less invasive, over the last decade there is a shift from physician delivered to technician delivered treatment, perhaps coupled with a relative lack in technological advancements and investment in SWL when compared to URS. Optimization of SWL with training and proper maintenance can offer better treatment outcomes, which in turn can decrease the overall cost of SWL [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Ureteroscopy is more cost effective than shock wave lithotripsy for stone treatment: systematic review and meta-analysis

et al. 2018

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IntroductionA rising incidence of kidney stone disease has led to an increase in ureteroscopy (URS) and shock wave lithotripsy (SWL). Our aim was to compare the cost of URS and SWL for treatment of stones.MethodsA systematic review and meta-analysis based on Cochrane and PRISMA standards was conducted for all studies reporting on comparative cost of treatment between URS and SWL. The cost calculation was based on factual data presented in the individual studies as reported by the authors. English language articles from January 2001 to December 2017 using Medline, PubMed, EMBASE, CINAHL, Cochrane library and Google Scholar were selected. Our study was registered with PROSPERO (International prospective register of systematic reviews)—registration number CRD 42017080350.ResultsA total of 12 studies involving 2012 patients (SWL-1243, URS-769) were included after initial identification and screening of 725 studies with further assessment of 27 papers. The mean stone size was 10 and 11 mm for SWL and URS, respectively, with stone location in the proximal ureter (n = 8 studies), distal ureter (n = 1), all locations in the ureter (n = 1) and in the kidney (n = 2). Stone free rates (84 vs. 60%) were favourable for URS compared to SWL (p < 0.001). Complication rates (23 vs. 30%) were non-significantly in favor of SWL (p = 0.11) whereas re-treatment rates (11 vs. 27%) were non-significantly in favor of URS (p = 0.29). Mean overall cost was significantly lower for URS ($2801) compared to SWL ($3627) (p = 0.03). The included studies had high risk of bias overall. On sub-analysis, URS was significantly cost-effective for both stones < 10 and ≥ 10 mm and for proximal ureteric stones.ConclusionThere is limited evidence to suggest that URS is less expensive than SWL. However, due to lack of standardization, studies seem to be contradictory and further randomized studies are needed to address this issue.

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Section: Discussionmentioning

confidence: 99%

Ureteroscopy is more cost effective than shock wave lithotripsy for stone treatment: systematic review and meta-analysis

et al. 2018

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“…7 Patients with any ureteric anatomical abnormalities that hinder the passage of stone fragments such as ureteric stricture should be excluded. 8 There should also be consideration of stone morphology as it is widely accepted that stones with an upper diameter of 20mm and a surface area of 115-180mm 2 are most suitable for management with SWL. However, stones that demonstrate density greater than 1000 Hounsfield Units show poor results.…”

Section: Discussionmentioning

confidence: 99%

Shockwave lithotripsy for urolithiasis: a 12-month analysis of referral data to a metropolitan Australian Hospital

Jaya

Nguyen²,

Tran

et al. 2020

Int Surg J

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Background: Extracorporeal shockwave lithotripsy (SWL) is still an important option in the treatment of renal tract stones. SWL is not without its limitations and alternatives should be considered. This study investigates the referral data to a new SWL planning meeting to identify reasons why SWL was not offered.Methods: A review of 12 months of data prospectively collected at a weekly stone meeting was supplemented with a retrospective chart analysis to identify the source of all referrals for SWL. The principal reason for diverting a patient to other stone management was noted.Results: 142 patients (median age 52 years) were referred for SWL over the 12-month period. SWL was not recommended in 40 (28.2%) patients. SWL was most commonly contraindicated due to excessive stone size±position (32.5%), anatomical complexity (25.0%) and radiolucency on x-ray (10.0%). The majority of patients who were diverted away from SWL were referred from an emergency department (32.5%) and the general urology clinics (20.0%).Conclusions: A significant portion of patients referred for SWL prove unsuitable for this method of stone clearance. This highlights an educational gap amongst clinicians regarding the indications and more importantly contraindications for SWL. Only 6.3% of total referrals originated from general practice suggesting a lack of awareness of the process of direct referral for SWL. Improving this with guidelines will relieve demand in outpatient clinics and help streamline patient care.

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“…Shockwave lithotripsy is the first line treatment in worldwide [21]. Shockwave Lithotripsy (SWL) is a non-surgical technique to treat kidney stones using high-energy shock waves [22]. A surgeon does the procedure in a hospital operating room or an outpatient surgery center.…”

Section: Discussionmentioning

confidence: 99%

The Role of Imaging in Diagnosis of Urolithiasis and Nephrolithiasis—A Literature Review Article

Gupta¹,

Li²,

Ji³

et al. 2019

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Urolithiasis or nephrolithiasis is a common ailment in the emergency room. The clinical presentation of a kidney stone includes fever, nausea, vomiting, acute flank pain radiating to the groin or the back. The pain is often described as stabbing and there is tachycardia, with or without hematuria for the severe patient. For the triad for urinary or kidney stones, some people say they are fever, vomiting, and acute flank pain. So in acute setting analgesia is given with or without an antiemetic to prevent vomiting IV fluids administered carefully. Noncontrast computed tomography (CT) is the gold standard for diagnosis. Most of urinary stones get washouts spontaneously if it is less than 5 mm without any intervention. However, if intervention is required either it is done by elective or as soon as possible by the intervention. I mean surgical management and surgical management will depend on how big the kidney stone is in there as well as where the kidney stone is if it is within the ureter or within the actual kidney.

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How can and should we optimize extracorporeal shockwave lithotripsy?

Cited by 48 publications

References 113 publications

Ureteroscopy is more cost effective than shock wave lithotripsy for stone treatment: systematic review and meta-analysis

Ureteroscopy is more cost effective than shock wave lithotripsy for stone treatment: systematic review and meta-analysis

Shockwave lithotripsy for urolithiasis: a 12-month analysis of referral data to a metropolitan Australian Hospital

The Role of Imaging in Diagnosis of Urolithiasis and Nephrolithiasis—A Literature Review Article

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