Extracorporeal shock-wave lithotripsy

Abstract

Ten years after the first application of extracorporeal shock-wave lithotripsy (ESWL), the technique has gained world-wide acceptance as first-choice therapy for urinary calculi. The introduction of different shock-wave sources, shock-wave coupling, and imaging techniques has influenced treatment comfort, the need for anesthesia, and the cost of the devices, hut has not improved the efficacy of treatment in terms of complete disintegration of calculi without the need for secondary treatment. The optimal device for lithotripsy, providing high efficacy without the need for anesthesia, while inducing minimal tissue trauma, has not yet been found. ESWL represents the first-choice therapy for ureteric stones without previous endoscopie manipulation. Under fluoroscopic imaging and high shock-wave energy, stone-free rates of up to 90% can be achieved. In the treatment of staghorn stones, ESWL monotherapy seems to be suitable for smaller calculi only, whereas larger stone burdens, classified by surface area, represent an indication for an initial percutaneous approach. Although neither method can achieve complete stone clearance in more than 80% of cases, the relief of symptoms and the elimination of infection are frequently achieved.