Transitioning from a mobile to on-site extracorporeal shockwave lithotripsy service: Is it worth it?

Abstract

Objectives:

The aim of this study was to compare the efficiency and effectiveness of a previous mobile versus current on-site lithotripsy service at a tertiary referral centre.

Methods:

Patient demographics, stone properties and service provision data were collected; retrospectively for mobile extracorporeal shockwave lithotripsy service (mESWL) between December 2017 and December 2018, and prospectively for on-site extracorporeal shockwave lithotripsy service (osESWL) between March 2019 and March 2020.

Results:

The overall stone clearance rate for mESWL was 57.1% (68/119) and 79.2% (164/207) for osESWL (p < 0.01). The overall osESWL ureteric stone clearance was 86.5% (77/89). The renal stone clearance rate with osESWL was greater than mESWL; 73.7% (87/118) versus 55.9% (62/111), p < 0.01. Waiting time for osESWL treatment to renal calculi was significantly lower than mESWL (35 versus 47 days), p < 0.01. To achieve stone clearance, mESWL required a larger proportion (25/111, 22.5%) of additional procedures compared to osESWL (16/118, 13.6%), p = 0.08. There was no significant difference in complication rates with mESWL versus osESWL. Over 5 years, there was a projected cost saving of £627,030 with osESWL compared to £158,660 with mESWL.

Conclusion:

With increased treatment capacity, higher stone clearance rate and shorter waiting times, the on-site lithotripter delivers a better service compared to a visiting mobile lithotripter. Furthermore, it may cut costs in the long term.

Level of evidence:

Not applicable.

Keywords

ESWL lithotripsy mobile fixed site renal ureteric

Get full access to this article

View all access options for this article.

References

Turney

Reynard

Noble

, et al. Trends in urological stone disease. BJU Int 2012; 109(7): 1082–1087.

GIRFT Academy. Urology: Towards better care for patients with acute urinary tract stones, 2022, https://www.gettingitrightfirsttime.co.uk/wp-content/uploads/2021/12/Urology_2021-12-10_Guidance_Acute-stones.pdf

NICE. NICE guideline NG118—Renal and ureteric stones: Assessment and management, 2019, https://www.nice.org.uk/guidance/ng118/resources/renal-and-ureteric-stones-assessment-and-management-pdf-66141605137093

NICE. NICE guideline NG118, economic analysis report – Renal and ureteric stones: Costing analysis of surgical treatments, 2019, https://www.nice.org.uk/guidance/ng118/evidence/costing-analysis-of-surgical-treatments-pdf-6654738349

Nafie

Dyer

Minhas

, et al. Efficacy of a mobile lithotripsy service: A one-year review of 222 patients. Scand J Urol 2014; 48(3): 324–327.

Parkin

Keeley

Jr Timoney

AG.

Re-auditing a regional lithotripsy service. BJU Int 2002; 89(7): 653–657.

Sumino

Mimata

Tasaki

, et al. Predictors of lower pole renal stone clearance after extracorporeal shock wave lithotripsy. J Urol 2002; 168(4 Pt 1): 1344–1347.

Ghalayini

Al-Ghazo

Khader

YS.

Extracorporeal shockwave lithotripsy versus ureteroscopy for distal ureteric calculi: Efficacy and patient satisfaction. Int Braz J Urol 2006; 32(6): 656–664; discussion 664–667.

Mobley

Myers

Jenkins

, et al. Effects of stents on lithotripsy of ureteral calculi: Treatment results with 18,825 calculi using the lithostar lithotriptor. J Urol 1994; 152(1): 53–56.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.09 MB