Transitioning from a mobile to on-site extracorporeal shockwave lithotripsy service: Is it worth it?

Objectives: The aim of this study was to compare the efficiency and effectiveness of a previous mobile versus current on-site lithotripsy service at a tertiary referral centre.Methods: Patient demographics, stone properties and service provision data were collected; retrospectively for mobile extracorporeal shockwave lithotripsy service (mESWL) between December 2017 and December 2018, and prospectively for on-site extracorporeal shockwave lithotripsy service (osESWL) between March 2019 and March 2020.Results: The overall stone clearance rate for mESWL was 57.1% (68/119) and 79.2% (164/207) for osESWL (p < 0.01). The overall osESWL ureteric stone clearance was 86.5% (77/89). The renal stone clearance rate with osESWL was greater than mESWL; 73.7% (87/118) versus 55.9% (62/111), p < 0.01. Waiting time for osESWL treatment to renal calculi was significantly lower than mESWL (35 versus 47 days), p < 0.01. To achieve stone clearance, mESWL required a larger proportion (25/111, 22.5%) of additional procedures compared to osESWL (16/118, 13.6%), p = 0.08. There was no significant difference in complication rates with mESWL versus osESWL. Over 5 years, there was a projected cost saving of 627,030 pound with osESWL compared to 158,660 pound with mESWL.Conclusion: With increased treatment capacity, higher stone clearance rate and shorter waiting times, the on-site lithotripter delivers a better service compared to a visiting mobile lithotripter. Furthermore, it may cut costs in the long term.