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Evolution of shockwave lithotripsy ( SWL ) technique: a 25‐year single centre experience of >5000 patients
Author(s) -
Jagtap Jitendra,
Mishra Shashikant,
Bhattu Amit,
Ganpule Arvind,
Sabnis Ravindra,
Desai Mahesh
Publication year - 2014
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12808
Subject(s) - hounsfield scale , medicine , lithotripsy , nuclear medicine , concomitant , group b , limiting , urology , surgery , computed tomography , mechanical engineering , engineering
Objective To assess the impact of various treatment optimisation strategies in shockwave lithotripsy ( SWL ) used at a single centre over the last 25 years. Patients and Methods In all, 5017 patients treated between 1989 and 2013 were reviewed and divided into groups A , B , C and D for the treatment periods of 1989–1994 (1561 patients), 1995–2000 (1741), 2001–2006 (1039) and 2007–2013 (676), respectively. The S onolith 3000 ( A and B ) and D ornier compact delta lithotripters ( C and D ) were used. Refinements included frequent re‐localisation, limiting maximum shocks and booster therapy in group B and Hounsfield unit estimation, power ramping and improved coupling in group D . Parameters reviewed were annual SWL utilisation, stone and treatment data, retreatment, auxiliary procedures, complications and stone‐free rate ( SFR ). Results The SFR with D ornier compact delta was significantly higher than that of the S onolith 3000 ( P < 0.001). The SFR improved significantly from 77.58%, 81.28%, 82.58% to 88.02% in groups A , B , C , and D , respectively ( P < 0.001). There was a concomitant decrease in repeat SWL (re‐treatment rate: A , 48.7%; B , 33.4%; C , 15.8%; and D , 10.1%; P < 0.001) and complication rates ( A , 8%; B , 6.4%; C , 4.9%; and D , 1.6%; P < 0.001). This led to a rise in the efficiency quotient ( EQ ) in groups A–D from 50.41, 58.94, 68.78 to 77.06 ( P < 0.001).The auxiliary procedure rates were similar in all groups ( P = 0.62). Conclusion In conclusion, improvement in the EQ together with a concomitant decrease in complication rate can be achieved with optimum patient selection and use of various treatment optimising strategies.