The primary advantages of offering this treatment option to your patients are that it is a non-invasive procedure with a very high first time clearance rate in excess of 85%. But because no incision is made and no invasive instruments are used, the risk of infection and post procedural complications are much reduced which negates the need for costly and time consuming multiple clinic or hospital follow up appointments.
Patients who undergo an ESWL procedure do not usually require an overnight stay in hospital so they can be treated as an outpatient and go home the same day, which saves time, money and resources for the patient, the urologists and the hospital.
When comparing an ESWL to a laser procedure, there is less risk of infection and damage to the ureter, moreover, due to the swift and successful nature of this procedure (a treatment usually takes around 45 minutes), treatment times, anaesthetic times and overall recovery times are considerably reduced.
Furthermore, ESWL patients usually require only one treatment, even to calculi located in the lower calyces, which are notoriously difficult to access, and often, if undertaken as a laser procedure, require multiple treatments to clear.
With the reduced staffing needs and the quicker overall recovery times, an ESWL procedure can significantly reduce costs to both hospital and patient and with the risk of post procedural complications sitting at less than 10%, this should be considered as the primary treatment option that can be offered to your patient.
Our State of the Art Equipment
Our service includes provision of the lithotripsy equipment, digital imaging system and ultrasound which enables us to visualise both radiopaque and radiolucent stones. We also provide an experienced lithotripsy radiographer with the expertise and technical support to undertake the procedure in a professional, safe and timely manner.
We run a specially equipped Iveco van that allows us to safely transport our Dornier Compact Delta Lithotripter equipment from hospital to hospital.
The Dornier Compact Delta can effectively fragment calculi of varying sizes from 2 to 20mm and beyond.
Whilst undertaking an ESWL procedure our carbon fibre table has the ability for the patient to be placed into the lithotomy position so that we can assist with stent placement and removal and/ or RPG. This then also negates the need to cancel the procedure or to call in radiological services. Saving time and at no extra cost. eg if a stent insertion is required prior to treatment.
Also, on the rare occasion when a radiolucent stone has fallen into the ureter where ultrasound localisation is not possible, we can screen with fluoroscopy whilst the urologist injects contrast to show a filling defect where the calculus is, thus giving the urologist a target.
One of the key factors for successful stone clearance is optimal stone localisation and therefore at Eastcoast Mobile Urology we are able offer both ultrasound and X-ray localisation techniques to ensure the best possible treatment outcome.
The main benefit of using ultrasound localisation is that the patient is not exposed to ionising radiation. This is optimal not only for the patient but also for all the theatre staff. Although lead gowns and thyroid shields are used during all radiological procedures using X-rays, one of the most radiosensitive parts of the body are the lens of the eyes and there is evidence that links ionising radiation exposure to the formation of cataracts.
Other benefits of ultrasound include the ability to identify both radiolucent and radiopaque stones which means that stones of different compositions including Calcium Oxalate, Calcium phosphate, Uric Acid, Cystine and Struvite stones can all be targeted successfully.
Furthermore, whilst using ultrasound you have a live image of what is happening in the kidney and can adjust the treatment protocols to suit accordingly.
However, ultrasound does have some limitations. If the stone is in the PUJ it can be more difficult to localise, particularly on large patients. If it is in the ureter localisation is not possible.
Lower calyx stones on obese patients can also offer a challenge as imaging can be difficult to interpret and localisation times can be somewhat longer than anticipated.
When ultrasound localisation is not suitable X-ray localisation can be utilised instead. The primary benefit of X-ray localisation is that it can identify radiopaque calculi anywhere within the renal collecting system. Localisation is generally very swift and easy to interpret, even with obese patients, although the calculi can sometimes be obscured by bowel gas. Yet, this can be easily overcome by obliquing the fluoroscopy unit in to the craniocaudial position so that the X-rays pass obliquely between the bowel gas and the calculi thus allowing the calculus to be targeted effectively.
However, X-ray localisation does also have its negative aspects.
The primary concern with ionising radiation exposure has already been mentioned. The secondary issue is that only radiopaque calculi can be imaged using this modality, radiolucent stones cannot be imaged at all.
Why use East Coast Mobile Urology?
Because they offer a dynamic approach to the treatment of Renal Calculi.
EMU were also instrumental in introducing the first non invasive, ionising radiation free paediatric kidney stone treatment option in Queensland, which has been so successful, that over the last 5 years 99% of all paediatric ESWL treatments undertaken in Brisbane have been achieve without the use of X-rays or fluoroscopy at all.
Furthermore, the advantages and benefits of using ultrasound localisation techniques in the treatment of renal calculi has been fully recognised by all the urologists that use EMU’s service, and as a consequence over 80% of all procedures carried out are now ultrasound guided.
Finally, EMU’s Radiographers are solely dedicated to ESWL treatments and between them have been successfully treating patients with renal calculi for more than 40 years.
With their vast and extensive reservoir of knowledge and clinical experience to draw upon, EMU’s Lithotripsy Radiographers have safely and effectively treated many thousands of renal calculi and as such must be considered an invaluable asset that can be utilised to ensure that best practice is followed and best patient outcome is achieved in a safe, professional and timely manner.