HOW UROLOGISTS ARE TRAINED IN SWL ?

One of the advantages of SWL relative to other surgical techniques for the treatment of patients with stone disease is its short learning curve. Indeed, SWL may be performed following a short training period for urologists, and there are even reports of SWL being successfully administered by medical technicians [1]. However, when SWL was first introduced, the training was rigorous and a typical training program consisted of the management of 25 consecutive patients for 5 to 10 working days [2]. Such experience was mandated to include pre-treatment evaluation and post-treatment patient care. The director of the SWL center was further required to have personal experience with at least 200 patients. A more recent survey of Canadian Urological Association members found that 70% of respondents rated SWL training as useful and relevant to practice [3]. However, at present there is no formal curriculum in SWL training, and organizations such as the American Urological Association do not have a formal didactic in this technology. We contend that SWL should not be viewed as routine, and that proper practice demands that the person in charge have a good grasp of the scientific basis of lithotripsy and an upto- date understanding of the mechanisms of SW action. In this regard, a greater emphasis on the training of urologists and lithotripsy technicians would be welcomed.

1. Ilker Y, Erton M, Simsek F, Akada A: Extracorporeal shock wave lithotripsy (ESWL) for urinary tract stones using Dornier MFL 5000, performed by the technician. Int Urol Nephrol 27: 511, 1995
2. Cockett AT: Extracorporeal shock wave lithotripsy training in the United States. J Urol 135: 1229, 1986
3. Morrison KB, MacNeily AE: Core comptencies in surgery: evaluating the goals of urology residency training in Canada. Can J Surg 49: 259, 2006

Article acceptance in Indian journal of Urology.

Today I got email from editor of Indian Journal of urology regarding provizinal acceptance of article on Lithotripsy in patient with renal stone associated with angiomyolipoma (AML).
Complete clearance was achived in one session. Technique was applying physics associated with shockwave, and not just shockwave.
Message:
"If we spend time in mastering the technique we would never fail in lithotripsy"

Its always application of technology which fails and not the technology!!!!!!!

Acute complications during and after extracorporeal shockwave lithotripsy Maheshwari PN - Indian J Urol

Acute complications during and after extracorporeal shockwave lithotripsy Maheshwari PN - Indian J Urol

2011 conference

Just back from conference 2011 held at goa.

Its was vey sad to know that one of the society is over powered by the company. Some speaker were so biased that they would rather deviate from gold standard treatment and engurage new brains to buy new technology. Even expensive and dont stand on the standard!!!!

History of Lithotripsy!!

The first reports on the fragmentation of human calculi with ultrasound appeared in the fifties. Initial positive results with an extracorporeal approach with continuous wave ultrasound could, however, not be reproduced. A more promising result was found by generating the acoustic energy either in pulsed or continuous form directly at the stone surface. The method was applied clinically with success. Extracorporeal shock-wave generators unite the principle of using single ultrasonic pulses with the principle of generating the acoustic energy outside the body and focusing it through the skin and body wall onto the stone. Häusler and Kiefer reported the first successful contact-free kidney stone destruction by shock waves. They had put the stone in a water filled cylinder and generated a shock wave with a high speed water drop which was fired onto the water surface. To apply the new principle in medicine, both Häusler and Hoff's group at Dornier company constructed different shock wave generators for the stone destruction; the former used a torus-shaped reflector around an explosion wire, the latter the electrode-ellipsoid system. The former required open surgery to access the kidney stone, the latter did not. It was introduced into clinical practice after a series of experiments in Munich.

How to choose lithotripsy unit ?

1. What is the focal zone of the lithotripter?
2. What is the peak pressure at the focal zone?
3. Is the energy delivery at focal zone consistent?
4. Is the energy delivered at focal zone adequate (not more than required for stone fragmentation)?
5. Do I have enough control over the energy delivered manually?
6. Do I have enough steps of increasing energy before I reach desired energy level?
7. Does every patient require anesthesia for lithotripsy?
8. Do I have dynamic monitoring of stone during lithotripsy?

Try to grade lithotripsy unit in following category.

Properties of lithotripsy		Machine A	Machine B	Machine C
Focal zone	Larger the better
Energy delivery at focal zone
Is the energy at focal zone constant
Control over the energy delivered manually	Does machine have manual selection of energy
Steps of increasing energy before you reach desired energy level	More the steps better
Patient require anesthesia (GA/SA)	Ideally no anesthesia or only analgesia should be required
Dynamic monitoring -USG	USG is better for Lithotripsy
Total score

Heel pain and ESWT

15 % of adults compain of heel pain
1 out of 8 patient visiting orthopedicean has heel pain
1/4 of all foot injury and 8% of overall injuries to runner and other athletes is heel pain


Only option available is Local steroid

But with now ESWT the results are amazing

Today ESWT is standard treatment for Plantar fasciatis

ESWT for Diabetic foot ulcer

Background: Diabetes is becoming one of the most common chronic diseases, and ulcers are its most serious complication. Beginning with neuropathy, the subsequent foot wounds frequently lead to lower extremity amputation, even in the absence of critical limb ischemia. In recent years, some researchers have studied external shock wave therapy (ESWT) as a new approach to soft tissue wound healing. The rationale of this study was to evaluate if ESWT is effective in the management of neuropathic diabetic foot ulcers.

Methods: We designed a randomized, prospective, controlled study in which we recruited 30 patients affected by neuropathic diabetic foot ulcers and then divided them into two groups based on different management strategies. One group was treated with standard care and shock wave therapy. The other group was treated with only standard care. The healing of the ulcers was evaluated over 20 weeks by the rate of re-epithelization.

Results: After 20 weeks of treatment, 53.33% of the ESWT-treated patients had complete wound closure compared with 33.33% of the control patients, and the healing times were 60.8 and 82.2 days, respectively (p < 0.001). Significant differences in the index of the re-epithelization were observed between the two groups, with values of 2.97 mm2/die in the ESWT-group and 1.30 mm2/die in the control group (p < 0.001).

Conclusion: Therefore, ESWT may be a useful adjunct in the management of diabetic foot ulceration.

Latest development in eswl

Have recently done a case of AML kidney with the renal stone have treated it with ESWL.
Isocentric sonography was used to localise the stone.

Soon telling you all the technique by my publication.

Pls let me know if there is any feedback on same

Thanks and regards