Extracorporeal shock wave lithotripsy today

Abstract

Even 32 years after its first introduction shockwave lithotripsy (SWL) remains a matter of discussion and controversy. Since the first SWL in 1980, millions of treatments have been performed worldwide. To this day SWL remains the least invasive of all stone treatments and is considered the treatment modality of first choice for the majority of urinary stones. Despite the massive scale on which SWL is performed in a wide range of indications, complication rate has always remained very low and usually limited to minor side effects and complications. The introduction of affordable multifunctional lithotripters has made SWL available to more and more departments of urology worldwide. Still many centers are disappointed with the treatment results and concerned about the adverse tissue effects. In this SWL proves to be the victim of its uninvasiveness and its apparent ease of practice. Urologists need proper skill and experience; however, to adequately administer shockwaves in order to improve outcome. This aspect is too often minimized and neglected. Apart from this the power of shockwaves often is underestimated by operators of shockwave machines. Basic knowledge of the physics of shockwaves could further reduce the already minimal adverse tissue effects. Good training and coaching in the administration of shockwaves would no doubt lead to a renaissance of SWL with better treatment results and minimal adverse tissue effects.

How can and should we optimize extracorporeal shockwave lithotripsy?

“…The next steps in the SWL procedure are identification of the target and optimal positioning of the patient [ 1 , 3 , 92 ]. Fluoroscopy is most commonly used [ 14 ], but ultrasound might also be used. The latter technique is used for identification of the radiolucent uric acid stones as an alternative to contrast medium.…”

Cross-sectional imaging of iatrogenic complications after extracorporeal and endourological treatment of urolithiasis

“…Symptomatic or clinically significant bleeding requiring blood replacement occurs in approximately 2 out of 1,000 treated patients. Similarly, a large multicentre study assessed the incidence of renal haematomas at 0.5 and 0.14 % following ESWL treatment of renal and ureteral stones respectively [ 4 , 9 – 11 , 13 – 16 ]. Retroperitoneal haemorrhage after ESWL may cause haemodynamic shock and occasionally be fatal [ 17 , 18 ].…”

Effects of previous unsuccessful extracorporeal shockwave lithotripsy treatment on the performance and outcome of percutaneous nephrolithotomy

“…Many medical centres are concerned about the adverse effects of ESWL on tissues [14] . Clinical and experimental studies have shown that this treatment might have severe, acute and chronic effects on the kidney and its peripheral tissues [15] , [16] , [17] .…”