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Thursday, February 27, 2014

Retrograde Intrarenal Surgery (RIRS) vs Extra Corporeal Shockwave Lithotripsy (ESWL)



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.

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