Acute extracorporeal shockwave lithotripsy (ESWL) for ureteric stones - 7-years' experience from a busy district general hospital

Introduction: ESWL is underutilised in ureteric stone management. The GIRFT report showed just four units nationally treated >10% of acute ureteric stones with ESWL. Despite guideline recommendations as a first-line treatment option, few large volume studies have been published. We present our experience of ESWL in 530 ureteric stone cases in the largest series we are aware of to date. Methods: Retrospective review of prospectively collected data between December 2012-February 2020 was performed. Data relating to patient demographics, stone characteristics, skin-to-stone distance, and treatment failure were collected. Cost analysis was conducted by the hospital trust's Head of Finance. Chi-squared analysis for statistical significance was performed. Results: A success rate of 67.9% with a mean treatment number of 1.7 sessions was observed (n=530). Statistically significant outcomes were observed for stone size (p=0.0001), stone density (Hounsfield units) (p=0.006) and skin-to-stone distance (p=0.03). Stone position was not statistically significant (p=0.54). However, the small number of stones treated >13mm or >1250HU had an approximate 50% chance of successful treatment. In our practice acute ureteric ESWL was found to be less costly than acute ureterorenoscopy, consistent with findings from previous NHS studies. Conclusion: Acute ESWL is a safe, reliable, and financially viable treatment option for a wider spectrum of patients than reflected in international guidelines based on our large, heterogenous series. In the COVID-19 era, with theatre access reduced and concerns over aerosol generating procedures, acute ESWL remains an attractive first-line treatment option.