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

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