Ambulatory extracorporeal shockwave lithotripsy in Australia.

Introduction & Objectives: Extracorporeal shockwave lithotripsy (SWL) is recommended as the primary treatment for renal and ureteric calculi less than 1 cm in size and as a possible treatment for larger calculi. Most health services in Australia do not have access to this in an emergency setting. We acquired only the second fixed site lithotripter in Victoria in late 2014. We report on the results of the first 1000 procedures. Material(s) and Method(s): All adult patients were treated in a dedicated lithotripsy unit within the diagnostic imaging department with no general anaesthesia on a Storz Medical Modulith SLK inline machine. Children were treated in an operating theatre with general anaesthesia. All demographic data was collected prospectively and patients were booked for review in a dedicated stone clinic with appropriate imaging. Stone free rates and the need for additional treatment were recorded. The study was approved by the local ethics committee. Result(s): 1007 procedures were performed on 817 renal units in 743 patients. 24.6% of treatments were on ureteric stones of which 35% were urgent (in-situ lithotripsy). Mean age was 52.09 (range 1-88), male:female 71:29%. Median stone size was 7 mm (range 2-35 mm). 15 (1.5%) procedures were performed on children. In adults, the majority, 778/992 (78.4%) were treated with just non-steroidal analgesia, 191 (19.3%) required opiates whether oral, intramuscular or intravenous, and 18 (1.8%) had no analgesia. 143 (17.5%) of renal units have either not yet been reviewed or lost to follow-up. Of the remainder 381 (56.5%) are either stone-free or have insignificant fragments, 278 (41.2%) have significant stone remaining. 169 (25%) underweny additional surgical treatment and 15 (2.2%) are awaiting further SWL. The remaining 73 (10.8%) are being reviewed expectantly. In-situ lithotripsy was successful in 55.5%. There have been 29 complications (2.9%) 12 of which were Clavien III or more. Conclusion(s): This is the first