Extracorporeal shock-wave lithotripsy

Abstract

Extracorporeal shock-wave lithotripsy (ESWL) has been available for active stone removal for more than 25 years. The efficiency and usefulness of this method for removal of stones from the kidney as well as from the ureter have been continuously reported, and the technique has stood the test of time. Modern lithotripters seem to be at least as powerful and efficient as the original unmodified 'gold standard' Dornier HM3 lithotripter. Stone-free rates of over 95% for ureteral stones can be expected, and a similar percentage of renal stones can be satisfactorily disintegrated. Whereas in almost all cases ureters become stone-free after ESWL, residual fragments are rather common after ESWL of renal stones. The future course of these fragments is difficult to predict, but in more than 60% of patients with residual fragments the situation wasessentially unchanged during a four-year follow-up. Although more invasive treatments such as ureterorenoscopy (URS) and percutaneous nephrolithotomy (PNL) may result in a higher rate of stone-free kidneys and ureters with fewer treatment sessions, the advantage of ESWL is its non-invasive or extremely low-invasive character. Moreover, in almost all cases the procedure can be completed without general or regional anaesthesia, on an outpatient basis and with a very low risk of complications. In combination with currently available pharmacological tools and, hopefully, with future improvements, it is my opinion that ESWL will continue to be the most attractive and least demanding method for active stone removal © Touch Briefings 2009.