Best Practices in Shock Wave Lithotripsy: A Comparison of Regional Practice Patterns

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. (C) 2014 Elsevier Inc.