Story of lithotripsy today!

Through years of personal research, and experience of over 18 years in lithotripsy. Every time I read the published article or attend a congress, I go back to my childhood days. The story told by my grandfather refreshes in my mind “the story of blind men and elephant” (link).
Story of lithotripsy is not much different than this story. Physicians are blinded by the lack of knowledge of lithotripsy. They have not put efforts to learn the technique of performing lithotripsy. They all accept HM3 as gold standard treatment, and later compare the result of todays lithotripter with HM3 without learning the technique and putting efforts to learn and master the technique. They have put all their efforts to master invasive procedures, if 50% of time was invested in learning the technique, today lithotripsy would have been on much higher level. Without learning the technique they speak out loud. Its old technology, it’s not efficient, it is not better than FURS(RIRS) or mini-perc, fragments are large, it leaves back residual stones. These statements are no different than the shout of the man in story who gave conclusion without having holistic approach to see big picture.
Not all shockwaves created by different technologies are same. Hence we see strong variation in results 25% to 90% on literature search

Not all shockwaves created by different lithotripters are equal

Shockwave lithotripsy revolutionized the treatment of kidney stones in the early 1980s – representing a huge leap in advancement of technology; from open surgical techniques to non-invasive ones.

Physicians took to the leap in technology with enthusiasm, and patients reaped the benefits. Over the years, systems became more user friendly, but also varied in key aspects.

The methods used to generate shockwaves were different – each method of shockwave generation having it’s own unique characteristics.

Developments in imaging modality in x-rays and ultrasound also provided a difference, with modern ultrasound providing better specificity and sensitivity than earlier versions.

The independent development of modern shockwave and imaging technology in certain devices has led to a variation of results in ESWL, depending on the specific device.

As such – “Not all shockwaves created by different lithotripters are equal”, as differences in shockwave generation and imaging modality are factors which influence treatment outcomes.

When evaluating Lithotripsy methods, physicians should bear this in mind – especially when comparing results of endourology with shockwave lithotripsy.

For further insight and perspective, it is recommended that ESWL and other methods of lithotripsy be classified further.

To remain truly unbiased, we recommend the following key factors should be highlighted in published articles (both for and against ESWL):

1. Shockwave generator technology
2. Imaging modality used
3. Energy delivered
4. Frequency of shockwaves

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Article on comparison of ESWL (Siemens Lithostar) with Flexible uretreoscopy (RIRS).

Abstract

To compare the outcomes of flexible ureterorenoscopy (F-URS) with extracorporeal shock wave lithotripsy (ESWL) for the treatment of upper or mid calyx kidney stones of 10 to 20 mm.

A total of 174 patients with radioopaque solitary upper or mid calyx stones who underwent ESWL or F-URS with holmium:YAG laser were enrolled in this study. Each group treated with ESWL and F-URS for upper or mid calyx kidney stones were retrospectively compared in terms of retreatment and stone free rates, and complications.

87% (n = 94) of patients who underwent ESWL therapy was stone free at the end of 3rd month. This rate was 92% (n = 61) for patients of F-URS group (p = 0.270 p > 0.05). Retreatment was required in 12.9% of patients (n = 14) who underwent ESWL and these patients were referred to F-URS procedure after 3rd month radiologic investigations. The retreatment rate of cases who were operated with F-URS was 7.5% (n = 5) (p = 0.270 p > 0.05). Ureteral perforation (Clavien grade 3B) was occured in 3 patients (4.5%) who underwent F-URS. Fever (Clavien grade 1) was noted in 7 and 5 patients from ESWL and F-URS group, respectively (6.4% vs 7.5%) (p = 0.78 p > 0.05).

F-URS and ESWL have similar outcomes for the treatment of upper or mid calyx renal stones of 10–20 mm. ESWL has the superiority of minimal invasiveness and avoiding of general anethesia. F-URS should be kept as the second teratment alternative for patients with upper or mid caliceal stones of 10–20 mm and reserved for cases with failure in ESWL.

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Master of Lithotripsy (ESWL) and ESWT: Classification of Lithotripter

Master of Lithotripsy (ESWL) and ESWT: Classification of Lithotripter