Today
we see lots of debate in the conference and seminar may be one of the most
discussed topic on treating kidney stone with RIRS (fURS) vs. ESWL or mini-PCNL
vs. RIRS (fURS). However at any point during the debate there is no emphasis on
the technology by which shockwave is produced Electrohydraulic (EH) /
Electromagnetic (EM) (most common technology of shockwave generation with few piezoelectric
lithotripters). Since the maximum installations are of EH, they are cheaper than
EM lithotripsy system. EH lithotripter have major market share.
It
is not fair to compare RIRS with EH lithotripter. A fair trial would be to
compare RIRS with USG guided ESWL on EM lithotripsy system. Today with such
advancement in shockwave technology and better understanding of physics of
stone fragmentation we fail to deliver results like HM3. One of the prime
reason is we have left the therapeutic application in hands of Technicians and
fail to take efforts to learn lithotripsy technology.
After
all said we compare results of ESWL done by a technician or junior most residents.
Technicians and junior residents who probably have never received any formal
training on lithotripsy, they have learned on his own by trial and error basis
to the results of RIRS which is done by a Surgeon and who has put his efforts
to learn RIRS. A well trained and groomed Lithotripsy Technician will always
deliver better results doing ultrasound guided ESWL on EM lithotripter when
compared to RIRS with much lesser morbidity and financial burden on then
patient and to the healthcare insurance provider.
