The Efficacy of Mobile ESWL Service (One year review)
Abstract Objective. Extracorporeal shockwave lithotripsy (ESWL) is the management of choice for ureteric and renal stones 20 mm or smaller, with a stone clearance rate of up to 89%. This study determined whether such a high success rate could apply to centres using mobile ESWL, by reviewing the performance at one centre that provides such a service. Material and methods. Between July 2011 and July 2012, 222 patients (median age 51 years, range 18-90 years) underwent one to five sessions of ESWL for ureteric and renal stones (mean size 15 mm, range 4-22 mm). Stone clearance was regarded as residual fragments 2 mm or smaller after completion of sessions. Results. In total, 110 out of 222 patients (49%) were clear of stones. Stones were radiopaque in 198 (89%) and radiolucent in 24 patients (11%), with clearance rates of 48% and 63%, respectively. Regarding size, 36 (16%) were 1-5 mm, 144 (65%) 5-10 mm, 28 (12%) 10-15 mm, eight (4%) 15-20 mm and six (3%) larger than 20 mm, with clearance rates of 61%, 55%, 18%, 13% and 50%, respectively. In total, 173 (78%) were renal stones and 49 (22%) ureteric, with respective clearance rates of 49% and 51%. For kidney stones, 15 (9%) were in the upper, 32 (18%) in the mid, 75 (43%) in the lower pole and 51 (30%) in the pelvis, with clearance rates of 52%, 59%, 49% and 41%; for ureteric stones, 32 (65%) were in the upper, 10 (20%) in the mid and seven (15%) in the lower ureter, with clearance rates of 47%, 70% and 43%, respectively. Conclusion. The performance of mobile ESWL was significantly poorer than expected, and this may be related to a lack of clinical ownership. The authors believe that such a service should be permanently placed on site.
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The Efficacy of Mobile ESWL Service (One year review)
- 1. Mr. Shady Nafie Urology Clinical Research Fellow Dr. Jonathan Mills FY1 in Urology Dr. Jaitender Minhas FY1 in Urology Mr. Masood A Khan Urology Consultant Mobile Lithotripsy Service The Efficacy of A one-year review of 222 patients Mr. James E Dyer Urology Clinical Research Fellow
- 2. • Introduced in February 1980 • Approved by FDA in 1984 • Dramatically changed the management of urinary tract stones Extra-corporeal Shock Wave Lithotripsy ESWL
- 3. EAU Guidelines ESWL can remove > 90% of stones in adults Stone Size ≤20 mm >20 mm Stone Clearance Rates 66-99% 45-63% Stone Clearance Rates (Dornier HM3 Lithotripter) 75-89% 39-63%
- 4. Success rate depends on: Lithotripter Patient Operator Stone • Efficacy • Size • Site • Density • Habitus (BMI) • Efficiency
- 5. LGH Performance • Storz MODULITH® SLK Lithotripter. • Dual localisation (Ultrasound, X-ray mobile image intensifier). • Technicians. • Middle grade doctor. July 2011 - July 2012
- 6. LGH Performance • Site. • Size. • Opacity. • Density. • Number. • Shocks. • Energy. Stones Sessions Stents • Yes/No • ≤2 mm residual stone, was considered stone clear. • Statistical analysis: Fisher’s exact test.
- 7. LGH Performance • 222 cases. • Mean Age: 51 yrs. (18-90). • Male : Female = 2.4 :1
- 8. LGH Performance Mean values: • Size: 15 mm (4-24) • Density: 811 HU (181-1711). • Shocks: 3185 (1550 - 4000). • Energy: 17.3 KV (9.8 - 20).
- 9. LGH Performance Number of ESWL sessions
- 10. LGH Performance Total Stone Clearance* Rate *≤2 mm residual stone, was considered stone clear.
- 11. LGH Performance Stone Clearance Yes No P-Value Number of Patients 110 112 N/A Mean HU 747 854 <0.05 Mean Shocks 3252 3155 <0.05 Mean Energy 17 17 0.732
- 12. LGH Performance Stone Size 61% 55% 18% 13% 50% P < 0.01
- 13. LGH Performance P = 0.577 Site Number Cleared Percentage Upper Pole 15 8 53% Middle Pole 32 19 59% Lower Pole 75 37 49% Kidney Pelvis 51 21 41% Upper Ureter 32 15 47% Middle Ureter 10 7 70% Lower Ureter 7 4 57% Stone Site
- 14. LGH Performance 46% Stent vs No Stent (Ureteric stones) 52% P = 0.394
- 15. LGH Performance 49% Stone Opacity 52% P = 0.829
- 16. LGH Performance 55% 33% P < 0.01 Stone Density (HU)
- 17. LGH Performance 53% Sex 42% P = 0.141
- 18. Conclusion The performance of our mobile ESWL service is significantly poorer than that expected. 49.5% 66-99%vs.
- 19. Factors affected Stone Clearance Rate Lithotripter Patient Operator Stone ?? Efficacy ✔ Size ✔ Density X Opacity X Site. X Stent X Sex ?? Habitus (BMI) ✔ No. of shockwaves ?? Energy level ?? Efficiency
- 21. Questions Dr. Jonathan Mills FY1 in Urology Dr. Jaitender Minhas FY1 in Urology Mr. Masood A Khan Urology Consultant Mr. Shady Nafie Urology Research Fellow Mr. James E Dyer Urology Research Fellow