시술자에 따른 체외충격파쇄석술의 성공률

Abstract

Purpose: The purpose of this study was to measure and compare the operator specific success rate of extracorporeal shock wave lithotripsy (ESWL), performed by 12 urologists in 1 unit, to determine the interoperator variation. Materials and Methods: Between September 1995 and September 2002, 1,434 patients with renal or ureteral stones received 2,697 ESWL treatments by 12 urologists (surgeons A to L), using a Storz Modulith SLXⓇ lithotripter. Measures of the patient outcomes included demographics, stone characteristics, technical details of lithotripsy, and session stone-free and final success rates according to operating urologist. Results: The mean session stone-free and final success rates were 44.8 (22.1-65.3) and 94.5% (86.7-99.4), respectively. Significant differences existed in mean number of shocks, fluoroscopy time and maximum treatment voltage delivered among the surgeons (p＜0.05). Surgeon H had significantly higher session stone-free (65.3%, p＜0.05) and final success rates (99.4%, p＞0.05). The mean number of shocks was higher for surgeons J (3,683) and H (3,606) than for the others (p＜0.05). The mean fluoroscopy time was higher for surgeon H, 4.44 minutes, than for the others ( ＜0.05). Mean maximum treatment voltage was higher for surgeons H (8.27), J (8.10) and I (8.05) than for the others (p＜0.05). Multiple analyses were performed by surgeon H. The fluoroscopy time (p=0.001) and the maximum treatment voltage (p=0.012) contributed greatly to the best results. Conclusions: We demonstrated clinically and statistically significant intrainstitutional differences in the final success rate following ESWL. The best results were obtained by the urologist who used the longest fluoroscopy time and highest maximum treatment voltage. (Korean J Urol 2005;46: 270-274)