Best practices in shock wave lithotripsy: A comparison of regional practice patterns - Abstract

OBJECTIVE: To evaluate regional differences in adaptation of best practice recommendations for extracorporeal shock wave lithotripsy (SWL) across 4 distinct geographic regions.

METHODS: A retrospective study was performed using a prospective database maintained by a mobile lithotripsy provider (ForTec Medical, Streetsboro, OH). SWL cases performed in Ohio, Northern Illinois/Southern Wisconsin, Florida, and New York were included. Treatment parameters evaluated included treatment rate, use of a power ramp-up protocol, use of a pretreatment pause after the initial 100 shocks, ancillary procedures, and need for retreatment. Regional and physician-specific patterns were examined. Statistical analyses using chi-square and analysis of variance were performed with a significance of P < .05.

RESULTS: Data from 2240 SWL procedures were included in the study. Overall adaptation of power ramp-up protocols and treatment rates were high (93% and 93%), whereas use of pause was lower (75%, P < .001). Retreatment rates were low (4.3%), although ancillary procedures were performed in 34% of patients, and 8.3% of patients received stents for stones < 1 cm. Regional differences were present in all parameters: Florida physicians used power ramp-up less (83%, P < .001) but had good use of pretreatment pause (98%, P < .001), both Wisconsin/Illinois and New York were less likely to use slow rate (87% and 84%, respectively, P < .001).

CONCLUSION: The recommendations for slower shock wave rates and power ramp protocols have reached high penetration in urologic practices; however, the more recent recommendation for a pause after the initial 100 shocks has been less uniformly implemented. Inconsistencies in regional adaptation of best practices may identify opportunities for further education.

Written by:
Brown RD, De S, Sarkissian C, Monga M.   Are you the author?
Stevan B. Streem Center for Endourology & Stone Disease, Glickman Urological & Kidney Institute, The Cleveland Clinic, Cleveland, OH.  

Reference: Urology. 2014 May;83(5):1060-4.
doi: 10.1016/j.urology.2014.01.017

PubMed Abstract
PMID: 24767521 Endourology Section