Stone fragmentation techniques

Abstract

After its implementation in 1980, shock wave lithotripsy (SWL) became the first-line treatment for more than 80% of patients with urolithiasis. During the last three decades, SWL technology has advanced rapidly in terms of shock wave generation, focusing, patient coupling, and stone localization. Indications for SWL have evolved as well. Although endoscopic treatment techniques continue to improve, SWL continues to be considered first-line therapy for the treatment of many urinary stones. This chapter reviews the fundamental principles of SWL and presents advances in lithotripsy technology such as shock wave generation and focusing, advances in stone localization (imaging), different energy source concepts, and coupling modalities. Our understanding of the pathophysiology and the physics of shock waves can enhance extracorporeal SWL efficacy while limiting complications. Finally, current indications for and contraindications to SWL depending on stone location and in context of the updated AUA/EAU Guidelines are discussed.