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Re-auditing a regional lithotripsy service.

J Parkin1, F X Keeley, A G Timoney

  • 1Department of Urology, Southmead Hospital, Westbury on Trym, Bristol BS10 5NB, UK. jkparkin@hotmail.com

BJU International
|April 23, 2002
PubMed
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This repeat audit of shock wave lithotripsy (SWL) shows improved patient selection but disappointing stone-free rates. Success rates improved when smaller fragments were included, with fixed-site lithotripters outperforming mobile units.

Area of Science:

  • Urology
  • Nephrology
  • Medical Technology

Background:

  • A previous audit in 1994 revealed suboptimal outcomes for shock wave lithotripsy (SWL), attributed to poor patient selection and limitations of the available fixed-site lithotripter.
  • Subsequent changes were implemented in a regional lithotripsy service to address these identified issues.

Purpose of the Study:

  • To evaluate the effectiveness of changes implemented in a regional lithotripsy service following a 1994 audit.
  • To assess improvements in patient selection and treatment outcomes for SWL.

Main Methods:

  • A repeat audit was conducted in 1999, collecting data on stone characteristics, lithotripsy treatment, and outcomes for the first 50 new patients at each center.
  • Data from mobile lithotripsy units were analyzed separately by machine, as only one hospital utilized a fixed-site lithotripter.

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Main Results:

  • Patient selection demonstrated improvement compared to previous audits, with fewer very large or very small stones treated.
  • Overall stone-free rates remained low (16.7-26.7%), but "overall success rates" (including fragments < 4 mm) ranged from 45.9% to 66.7%.
  • The fixed-site lithotripter unit showed better performance (two-thirds success) than mobile units (Modulith SLX: 51%, Modulith SLK: 46%), though one center using both mobile machines had a 65% success rate with higher auxiliary procedure rates.

Conclusions:

  • Despite improvements in patient selection for the regional lithotripsy service, stone-free and success rates are lower than reported benchmarks.
  • The findings suggest a need to re-examine success rate metrics for modern SWL, potentially influenced by machines enabling day-case treatment with minimal analgesia.