Initial experiences of starting a new regional extracorporeal shockwave lithotripsy (ESWL) service during a global pandemic

ABSTRACT

Introduction: The 2018 GIRFT report and 2019 NICE renal and ureteric stone guidelines recommended regional, fixed-site lithotripsy units to provide elective and emergency extracorporeal shockwave lithotripsy (ESWL) for urinary tract calculus <20 mm. In our region, Trusts were serviced by a mobile lithotripter, which was unable to provide adequate emergency treatment, as such a new fixedsite regional service was developed. Methods: The ongoing pandemic resulted in many challenges in the service development, including a reduction in urological operating by 25% during the COVID-19 pandemic, with additional loss of capacity as only patients ASA 2 or below was able to be treated in peripheral centres. A new pathway was introduced aiming to reduce admissions to surgical wards, instead moving directly to treatment and pain relief at home, in line with the 2019 NHS long-term plan. After 6 weeks of treating local patients, the service was opened to Trusts across the region to enable equal access for all patients' for both emergency and elective ESWL. Results: In the first 6 months, 144 local stones were treated with ESWL (38 ureteric and 106 renal), of which 118 (81.9%) were successfully cleared, with the NICE guidelines quoting success rates between 72.4% and 83.8%. Across that period, this would have required 40 additional operating sessions (160 operative hours) to treat these stones ureteroscopically. With ureteroscopy £2347 more expensive than ESWL to get stone clearance (Constanti et al. BJUI 2020;125 457-466), the treatment cost saving in the first 6 months is £281,666. In addition, 53 stones were treated as an emergency from the region, with a stone clearance rate of 81% and 53% treated within 48 hours. Conclusion: The new ESWL service has resulted in regional stone treatments with success rates in line with published data, in addition to providing economic and operative capacity benefits during a global pandemic.