Introduction: We reported earlier that hands-on training (HOT) significantly improved the SWL success rate from 66.3% to 87.2% at the AUA annual meeting 2012. In this study, we tracked SWL outcome by urologists who completed the training and analyzed factors that contribute to further success of treatment.
Methods: Among SWL treatments conducted from December 2011 to May 2018, 458 cases evaluated by CT after 3 months were retrospectively analyzed. The treatment success was positioned as complete elimination or < 4 mm residual fragments by CT. The HOT has been held once a year, and all 20 urologists who were in charge of operation received one or more HOTs. Regarding the contribution to the success of treatment, the following factors related to treatment were examined using logistic regression analysis; patient factors (age and body mass index (BMI)), stone factors (size, CT value, stagnation period, and stone-skin distance (SSD)), therapeutic factors (compliance rate of recommended technique, number of treatments, stent indwelling, body position, use of stretcher wedge, targeting method, air removal, shock wave number and frequency), instrument factor (model and number of days elapsed since maintenance).
Results: The total success rate was 84.3%. The compliance rate of the technique recommended by HOT was 83.0%, and the success rates of compliance group and noncompliance group were 86.1% and 75.6% (p = 0.03), respectively. In multivariate analysis, initial treatment, stone size less than 9 mm, supine position, and no stent were contributing factors of treatment success. Contributing factors by stone location were as follows; no stent indwelling in the renal collecting system, supine position and the stones size less than 9 mm in the proximal ureter, hydronephrosis less than G2 in the mid ureter, and stagnation period less than 3 months in the distal ureter. Among all treatments, 171 cases were conformed to the condition of "initial treatment, stone less than 9 mm, supine position, without stent", and its success rate was 93.6%. Furthermore, among these cases, the success rate of 132 patients treated with the technique recommended by HOT was 100%.
Conclusions: Continuous hands-on training on SWL technique was found to be able to keep the treatment success rate high. Appropriate case selection and compliance with HOT technique can dramatically improve SWL success rate. Source of