What have we learned about shock wave lithotripsy in the past thirty years?

Abstract

Shock wave lithotripsy (SWL) has revolutionized the treatment of kidney stone disease since its introduction in the early 1980s. Considering the paucity of knowledge about the bioeffects of shockwaves in various tissues and renal concretions 30 years ago, the success of SWL is a truly remarkable fest on its own. We have learned a lot since then. New technologies have been introduced for shock wave generation, focusing, and measurement, among others. In parallel, new knowledge has been acquired progressively about the mechanisms of stone comminution and tissue injury. Yet there are still outstanding issues that are constantly debated, waiting for resolution. In this talk, the quest for a better understanding of the shockwave interaction with stones and renal tissue in the field of SWL will be reviewed in chronological order. Focus will be on stress waves and cavitation for their distinctly different (for their origin), yet often synergistically combined (in their action), roles in the critical processes of SWL. This historical review will be followed by a discussion of the recent development and future prospects of SWL technologies that may ultimately help to improve the clinical performance and safety of contemporary shock wave lithotripters. [Work supported by NIH through 5R37DK052985-18.]