Equivalence of mobile and fixed lithotriptors for upper tract stones

Although mobile renal lithotripsy appears to be a cost-efficient method for a urologist to treat patients at the local hospital the quality issue has been raised with occasional use of a mobile lithotriptor. We reviewed 4,278 kidneys in 3,900 patients treated by 129 urologists using a mobile Dornier HM3 and a mobile Medstone lithotriptor at 21 mobile sites in 6 upper midwest states during 3 1/2 years. These results were compared with those in 524 kidneys in 480 patients treated by our fixed Medstone lithotriptor. After the procedure auxiliary treatments were needed in 3% of the patients treated with the mobile units and 2% of those treated with the fixed unit. The rate in 2 large published series was approximately 9%. The retreatment rates were 5% with the mobile lithotriptors and 6% with the fixed (reported average 16%), and the over-all stone-free rates at 3 months were 69% and 68% (versus 66%). Of note, the mobile units were as effective as the fixed unit against difficult stones. A mobile lithotriptor with a constant support staff that is used 1 or 2 times per month by many trained urologist will perform as well as fixed lithotriptor used regularly by a small unvarying staff of trained urologists.