Complications of Extracorporeal Shock Wave Lithotripsy for Urinary Stones: To Know and to Manage Them—A Review

Abstract

To identify the possible complications after extracorporeal shock wave lithotripsy (SWL) and to suggest how to manage them, the significant literature concerning SWL treatment and complications was analyzed and reviewed. Complications after SWL are mainly connected to the formation and passage of fragments, infections, the effects on renal and nonrenal tissues, and the effects on kidney function. Each of these complications can be prevented adopting appropriate measures, such as the respect of the contraindications and the recognition and the correction of concomitant diseases or infection, and using the SWL in the most efficient and safe way, tailoring the treatment to the single case. In conclusion, SWL is an efficient and relatively noninvasive treatment for urinary stones. However, as with any other type of therapy, some contraindications and potential complications do exist. The strictness in following the first could really limit the onset and danger of the appearance of others, which however must be fully known so that every possible preventive measure be implemented.

Efficacy of poly(adenosine diphosphate-ribose) polymerase inhibition in extracorporeal shock wave-induced renal injury

“…1,2 After ESW, the most frequently observed sign of kidney is hematuria, while less often perirenal, subcapsular, or intrarenal hematomas or other symptomatic fluid collections are observed. 3,4 In recent reports, one of the mechanism discussed for tissue damage in ESW is free oxygen radical production. 2 Concerning the mechanism of the adverse effects of ESW, although initially they were attributed to renal damage resulting only from the direct action of cavitation bubbles or shear stress originating from shock-wave energy, more recently free oxygen and nitrogen radical production originating from transient ischemia due to ESW application was considered to be an integral element in shock wave-induced renal damage through an indirect mechanism.…”

Strategies to optimize shock wave lithotripsy outcome: Patient selection and treatment parameters

“…Hydronephrosis and renal insufficiency are also associated with lower success rates but the mechanism for this is unknown [34] . Anticoagulation, bleeding disorders, pregnancy, severe skeletal malformations, distal obstruction, and infection associated with obstruction are all absolute contraindications to SWL (Table 3) [6,35] . While some patients may still choose SWL despite not satisfying all criteria, keeping these general principles in mind regarding stone-specific characteristics and patient features when electing SWL will improve the procedure success rate.…”

Urinary level of interleukin-1alpha and interleukin-6 in patients underwent extracorporeal shock wave lithotripsy

“…Although it is considered as a noninvasive method, ESWL as well as any other treatment has its own complications which causes acute and rarely chronic damages including renal damage, renal colic pain for more than 24 hours, transient hydronephrosis and dermal ecchymosis. It can also lead to urinary tract infection, hypertension and hematuria (10,11). The exposure of shock waves for the purpose of destructing urinary calculi could have been undesirable effects on the soft tissues and vascular system of urinary tract.…”