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Mr. Shady NafieUrology Clinical Research
Fellow
Dr. Jonathan MillsFY1 in Urology
Dr. Jaitender MinhasFY1 in Urology
Mr. Masood A KhanUrology Consultant
Mobile Lithotripsy ServiceThe Efficacy
of
A one-year review of 222 patients
Mr. James E DyerUrology Clinical Research
Fellow
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•Introduced in February 1980•Approved by FDA in 1984•Dramatically changed the
management of urinary tract stones
Extra-corporeal Shock Wave LithotripsyESWL
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EAU GuidelinesESWL 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%
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Success rate depends on:
Lithotripter
Patient Operator
Stone
• Efficacy
• Size• Site• Density
• Habitus (BMI)
• Efficiency
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LGH Performance
•Storz MODULITH® SLK Lithotripter.•Dual localisation (Ultrasound, X-ray
mobile image intensifier).•Technicians.•Middle grade doctor.
July 2011 - July 2012
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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.
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LGH Performance•222 cases.•Mean Age: 51 yrs. (18-90).•Male : Female = 2.4 :1
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LGH PerformanceMean values:•Size: 15 mm (4-24)•Density: 811 HU (181-1711).•Shocks: 3185 (1550 - 4000).•Energy: 17.3 KV (9.8 - 20).
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LGH PerformanceNumber of ESWL sessions
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LGH PerformanceTotal Stone Clearance* Rate
*≤2 mm residual stone, was considered stone clear.
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LGH PerformanceStone 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
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LGH PerformanceStone Size
61%
55%
18%
13%
50%
P < 0.01
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LGH Performance
P = 0.577
Site Number Cleared PercentageUpper 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
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LGH Performance
46%
Stent vs No Stent (Ureteric stones)
52% P = 0.394
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LGH Performance
49%
Stone Opacity
52% P = 0.829
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LGH Performance
55%
33% P < 0.01
Stone Density (HU)
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LGH Performance
53%
Sex
42% P = 0.141
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ConclusionThe performance of our mobile ESWL
service is significantly poorer than that expected.
49.5%
66-99%vs.
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Factors affected Stone Clearance Rate
Lithotripter
Patient Operator
Stone
?? Efficacy
✔ Size✔ DensityX OpacityX Site.X Stent
X Sex?? Habitus (BMI)
✔ No. of shockwaves?? Energy level?? Efficiency
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Conclusion
Maintenance?
Technician?
Lack of Ownership?
Mobile ESWL
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Questions
Dr. Jonathan Mills
FY1 in Urology
Dr. Jaitender MinhasFY1 in Urology
Mr. Masood A Khan
Urology Consultant
Mr. Shady NafieUrology Research
Fellow
Mr. James E DyerUrology Research
Fellow