Extracorporeal Shock Wave Lithotripsy Research Articles

Impact of hydronephrosis on shockwave lithotripsy outcomes for upper ureteral stones.

To investigate the effect of the degree of hydronephrosis on extracorporeal shockwave lithotripsy (SWL) success in patients who underwent SWL due to upper ureteral stones. Medical records of 878 patients who underwent SWL were retrospectively reviewed. Patients with isolated unilateral 6-10mm radiopaque upper ureteral stones above the upper border of the sacroiliac joint were included in the study. The primary endpoint of the study was the relationship between the degree of hydronephrosis with upper ureteral stones and the stone clearance time, number of SWL sessions, and success, while the secondary endpoint was the effect of the presence of severe hydronephrosis (SFU grade 3) on SWL success. The mean age of the patients was 41.3 ± 10.9years. The mean stone size was 8.2 (6-10) mm. Ureteropelvic junction stones were present in 24 (20%) patients. The mean stone clearance time was 14.6 ± 9.7days. One-month SWL success was determined as 85%. SWL success rates decreased as the degree of hydronephrosis increased (p = 0.047). Being 45years of age and older increased the risk of SWL failure by 16.25 times (OR = 16.25, p = 0.017). Increasing the stone clearance time by 1day increased the risk of SWL failure by 1.17 times (OR = 1.17, p = 0.006), and increasing the number of SWL sessions by 1 session increased the risk of SWL failure by 7.69 times (OR = 7.69, p = 0.016). The presence of severe hydronephrosis (grade 3) did not affect SWL success (OR = 5.56, p = 0.071). According to our study results, as the degree of hydronephrosis increases in 6-10mm upper ureteral stones, the number of SWL sessions increases, stone expulsion times prolong, and 1-month success rates decrease.

Endoscopic Management of Benign Pancreaticobiliary Disorders

Endoscopic management of benign pancreaticobiliary disorders encompasses a range of procedures designed to address complications in gallstone disease, choledocholithiasis, and pancreatic disorders. Acute cholecystitis is typically treated with cholecystectomy or percutaneous drainage (PT-GBD), but for high-risk or future surgical candidates, alternative decompression methods, such as endoscopic transpapillary gallbladder drainage (ETP-GBD), and endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD), are effective. PT-GBD is associated with significant discomfort as well as variable adverse event rates. EUS-GBD leverages lumen-apposing metal stents (LAMS) for direct access to the gallbladder, providing the ability to treat an inflamed GB internally. Choledocholithiasis is primarily managed with ERCP, utilizing techniques to include balloon extraction, mechanical lithotripsy, or advanced methods such as electrohydraulic or laser lithotripsy in cases of complex stones. Altered anatomy from bariatric procedures like Roux-en-Y gastric bypass may necessitate specialized approaches, including balloon-assisted ERCP or EUS-directed transgastric ERCP (EDGE). Post-operative complications, including bile leaks and strictures, are managed endoscopically using sphincterotomy and stenting. Post-liver transplant anastomotic and non-anastomotic strictures often require repeated stent placements or advanced techniques like magnetic compression anastomosis in refractory cases. In chronic pancreatitis (CP), endoscopic approaches aim to relieve pain and address structural complications like pancreatic duct (PD) strictures and calculi. ERCP with sphincterotomy and stenting, along with extracorporeal shock wave lithotripsy (ESWL), achieves effective ductal clearance for PD stones. When traditional approaches are insufficient, direct visualization with peroral pancreatoscopy-assisted lithotripsy is utilized. EUS-guided interventions, such as cystgastrostomy, pancreaticogastrostomy, and celiac plexus blockade, offer alternative therapeutic options for pain management and drainage of peripancreatic fluid collections. EUS plays a diagnostic and therapeutic role in CP, with procedures tailored for high-risk patients or those with complex anatomy. As techniques evolve, endoscopic management provides minimally invasive alternatives for patients with complex benign pancreaticobiliary conditions, offering high clinical success and fewer complications.

Comparative Study between Ultrasound Guided Anterior and Posterior Approaches of Quadratus Lumborum Block in Extracorporeal Shock Wave Lithotripsy

Comparative Study between Ultrasound Guided Anterior and Posterior Approaches of Quadratus Lumborum Block in Extracorporeal Shock Wave Lithotripsy

Predictive Modeling Is a Reliable Indicator in Determining Excessive Renal Mobility Single-Center Randomized Study.

Purpose: Excessive kidney mobility is an underestimating challenge for surgeons during retrograde intrarenal surgery (RIRS) and extracorporeal shock wave lithotripsy (ESL). There is no technique approved as a gold standard procedure for reducing excessive kidney mobility. The study aimed to uncover predictive factors for determining excessive renal mobility by utilizing clinicodemographic characteristics and noncontrast computed tomography (NCCT) data. Materials and Methods: The patients were categorized into two groups based on the presence of excessive renal mobility. Patients were scanned with a 16-channel, multislice NCCT, and images were captured utilizing a 16 × 1.25 mm collimation, 5 mm slice thickness. Many parameters including the origin angle of the renal artery, renal artery, vein length, diameter, the area and length of the psoas muscle, and perirenal and pararenal fatty tissue were measured on the images and analyzed. The data were analyzed using multivariate logistic regression, and the receiver operating characteristic curve model and we used predictive modeling based on three significant parameters. Results: Between May 2023 and May 2024, a total of 140 patients with and without excessive renal mobility enrolled into study. After multivariate analysis, increasing renal vein length and renal artery origin angle results in higher renal motility (odds ratio [OR]: 0.982; 95% confidence interval [CI]: 0.966-0.998; p = 0.030 and OR: 0.973; 95% CI: 0.948-0.999; p = 0.044; respectively). It also observed that an increase in tidal volume led to a reduction in renal mobility (OR: 1.015; 95% CI: 1.007-1.024; p = 0.001). Predictive modeling was designed based on these outcomes. This predictive modeling accurately estimates the presence of excessive renal mobility with improved 59% specificity and 65% sensitivity (p < 0.001, area under the curve 0.757; CI: 0.671-0.843). Conclusion: Physicians may predict the presence of excessive renal mobility via the predictive modeling mentioned in the current article. They may perform manipulations to reduce kidney mobility prior to ESL and RIRS.

Endoscopic retrograde cholangiopancreatography combined with extracorporeal shock wave lithotripsy for the removal of large gallbladder stones: a pilot study

BackgroundEndoscopic gallbladder-preserving cholecystolithotomy (EGPC) has become an alternative option for treating cholecystolithiasis. However, developing a new method of EGPC in which the gallbladder wall is not damaged remains a challenge. This study introduced a new EGPC method called endoscopic retrograde cholangiopancreatography (ERCP) combined with extracorporeal shock wave lithotripsy (ESWL), which preserves the integrity of the gallbladder wall in the treatment of cholecystolithiasis complicated with choledocholithiasis.MethodsIn total, six patients (aged 23–72 years, 3 males and 3 females, Han ethnicity) who had large gallbladder stones (diameter ≥ 1 cm) complicated with common bile duct (CBD) stones and who underwent ERCP combined with ESWL at the First Affiliated Hospital of Nanchang University from July 2022 to December 2022 were enrolled. The patients’ clinical characteristics, endoscopic treatment and follow-up data were analyzed. A paired t test was performed to compare the differences in the main serological indicators before and after EGPC.ResultsOf the six patients, five completed EGPC, and one failed due to intolerable abdominal pain during ESWL and was subsequently transferred to surgery. With respect to post-EGPC adverse events, one patient developed mild post-ERCP pancreatitis, and no other adverse events occurred. Both the technical success rate and clinical success rate of ERCP combined with ESWL were 83.3% and the incidence of adverse events was 16.7%. The six patients were followed up for an average of 24 months, during which only one patient experienced a recurrence of gallbladder stones at the 3-month follow-up, but no gallbladder stones were found at the 6-month follow-up after oral administration of ursodeoxycholic acid.ConclusionsERCP combined with ESWL is a potentially safe and effective treatment for large gallbladder stones.Trial registrationThis study was registered at the Chinese Clinical Trial Registry site. [Registration number: ChiCTR2200060927 (http://www.chictr.org.cn/); registration date: June 14, 2022].

Predicting Risk Factors Affecting the Efficacy of Flexible Ureteral Holmium Laser Lithotripsy and Extracorporeal Shock Wave Lithotripsy for Ureteral Calculi Based on Decision Tree Model.

To evaluate the efficacy of flexible ureteroscopic lithotripsy (FURL) and extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteral calculi based on decision tree model. A total of 600 patients with ureteral calculi, including 289 treated with FURL and 311 cases with ESWL in Anqing Municipal Hospital from June 2021 to August 2023, were selected as study subjects. Perioperative indicators and stone clearance rate of the two groups were compared, and the preoperative and postoperative (24 and 72 hours) changes of serum creatinine, cystatin C (Cys-C) and microalbumin were observed. The complications during and 7 days after treatment, the influence of perioperative indexes, total stone removal rate and renal function indexes were analyzed using decision tree method, and a complication risk prediction model was constructed. The operation time, length of hospital stays and postoperative hematuria time in FURL group were shorter than those in ESWL group (p < 0.001), and the usage of painkillers was less frequent in FURL group than in ESWL group (p = 0.002). The total stone removal rate in the FURL group was higher than that in the ESWL group (p < 0.001). Serum creatinine, urinary microalbumin and Cys-C in both groups were lower before surgery than at 24 h and 72 h after surgery (p < 0.05). Serum creatinine, urinary microalbumin and Cys-C in FURL group were lower than those in the ESWL group at 24 and 72 h after operation (p < 0.001). The overall complication rate in the FURL group was lower than that in the ESWL group (p = 0.028). Decision tree model analysis showed that four explanatory variables, including preoperative creatinine, urinary microalbumin, Cys-C and surgical method were identified by screening. The risk statistic of the model was 0.027, and the accuracy, sensitivity and specificity of the model in predicting postoperative complications in patients with ureteral calculi were 97.33%, 97.73% and 97.30%, respectively. FURL has significant advantages over ESWL in the treatment of ureteral calculi, and has less impact on renal function and fewer complications. Preoperative creatinine, urinary microalbumin, Cys-C and surgical methods may adversely influence the occurrence of postoperative complications. These identified factors can be employed to build a decision tree model for predicting the occurrence of postoperative complications.

Comparative retrospective analysis of magnetic field therapy and extracorporeal shock wave therapy in pain management for heel spur

Comparative retrospective analysis of magnetic field therapy and extracorporeal shock wave therapy in pain management for heel spur

Ultrasonographic and pedobarographic evaluation of the effectiveness of extracorporeal shock wave therapy in patients with plantar fasciitis

Ultrasonographic and pedobarographic evaluation of the effectiveness of extracorporeal shock wave therapy in patients with plantar fasciitis

Comparison of the effectiveness of 2 shockwave therapy protocols for the treatment of vascular erectile dysfunction: a randomized, multicenter, open-label, noninferiority, phase 4 clinical trial.

Shockwave therapy is an optional adjuvant treatment for vascular erectile dysfunction (ED). There is variability in treatment protocols and challenges with patients adherence to the weekly protocol, which is the most commonly used. This study aimed to evaluate the noninferiority of a monthly shockwave therapy protocol compared to the weekly protocol for treating vascular ED. A randomized, open-label, control active, multicenter clinical trial was conducted. A total of 184 men diagnosed with vascular ED, without comorbid conditions associated with secondary dysfunction or active treatment for ED, were included across 5 clinics in Mexico and Colombia. Patients were randomized to receive either 6 sessions of weekly or monthly shockwave therapy, applying the same parameters for both groups. The primary outcome was the change in the International Index of Erectile Function-Erectile Function Domain (IIEF-EF) Questionnaire score at 24weeks after treatment, assessed using a noninferiority approach. Secondary outcomes included clinical improvement, erection hardness, and self-esteem (SEAR Questionnaire) at posttreatment, 12weeks, and 24weeks of follow-up. At 24-week posttreatment, the average change in IIEF-EF was 1.93 (± 6.55; 95% CI 0.49-3.38) in the weekly group and 4.30 (± 6.78; 95% CI 2.69-5.9) in the monthly group, demonstrating noninferiority of the monthly protocol (difference -2.36; 95% CI -4.4 to -0.2; noninferiority P< .0001). At the end of treatment, clinical improvement was achieved by 55.2% of participants in the monthly protocol and 30.9% in the weekly (P= .042). No significant differences were found in other outcomes. A 6-session monthly shockwave therapy regimen could improve erectile function in men with ED. This is the largest clinical trial to date evaluating shockwave therapy regimens for ED. The principal limitations were the absence of objective vascular assessment of the changes produced by shockwaves, and the absence of a placebo control group. A monthly protocol of 6 shockwave therapy sessions is noninferior to a weekly protocol up to 6 months after therapy, in men with vascular ED.

Artificial Intelligence in the Prediction of Stone-Free Status in Urinary Stone Disease Treated with Extracorporeal Shockwave Lithotripsy: A Systematic Review

Background Urolithiasis is one of the most common urological diseases worldwide. One of the most common therapy, extracorporeal shock wave lithotripsy (ESWL), has a high failure rate. The failure rate can be significantly reduced by identifying the candidates most likely to benefit from ESWL, for example, by using machine learning (ML) algorithms. Decision tree analysis (DTA), artificial neural networks (ANN), and random forests (RF) represent a few of the machine learning approaches employed to forecast the stone-free outcome following ESWL. Methods 219 studies were searched through six electronic databases (CENTRAL, MEDLINE, EMBASE, EBSCO, Proquest, SCOPUS). We employed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and adhered to the Standards for Reporting Diagnostic Accuracy Studies (STARD). To evaluate the potential bias in all the studies, we utilized the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Results 41,484 patients from 11 studies were included. The ML models highlight varying levels of diagnostic precision, with sensitivity spanning from 35-96%, and specificity ranging from 63-98.4%, and area under the curve falling between 0.49-0.96. It is shown in this study that the accuracy of RF and DTA in predicting stone-free status is superior than ANN. Conclusion ML is a comparable predictive method to statistical analysis in predicting stone-free status. Random forest method and DTA are superior MLs compared to ANN. Stone size, density, and 3D texture analysis are the most important variables to be considered in the ML models and should be included in the models to ensure accuracy of stone-free status prediction.

Comparing the long-term effect of extracorporeal shockwave therapy and therapeutic ultrasound in treating trigger finger: A prospective cohort study.

To investigate the long-term effects of Extracorporeal shockwave therapy (ESWT) and ultrasound (US) in treating the trigger finger. Trigger finger, also known as stenosing tenosynovitis, is a common type of tenosynovitis affecting the flexor sheath of any finger. Extracorporeal shockwave therapy and therapeutic US are conservative treatments that use waves of varied frequency to target damaged regions and improve function. This cohort study was carried out in Saudi Arabia, using samples obtain from the files of patients with trigger fingers who visited the orthopedic department at Al-Rass General Hospital between May and June 2023. Of the 38 people with trigger fingers who were initially included, 24 satisfied the requirements for inclusion (11 underwent US, and 13 received ESWT). Assessments were conducted in September 2023, two months later. A goniometer was used to measure the range of motion (ROM), an electrical dynamometer was used to test grip strength, a numerical pain rating scale was used to quantify discomfort, and QuickDASH was used to measure general functional capacity. Extracorporeal shockwave therapy and US significantly affected all outcomes, including pain severity, ROM, hand strength, and general functional capability (p<0.005). In the immediate period, the US outperformed ESWT in enhancing general functional capability. Over time, ESWT was more essential for reducing pain (p=0.001). This study provides preliminary evidence that ESWT and US have similar effects in treating trigger fingers.

Effects of transcranial magnetic stimulation combined with extracorporeal shockwave therapy for poststroke spasticity: study protocol for a randomised controlled trial

IntroductionSpasticity is a common complication of stroke, which is related to poor motor recovery and limitations in the performance of activities. Both transcranial magnetic stimulation (TMS) and extracorporeal shockwave therapy...

Extracorporeal Shock Waves Therapy for the Treatment of Acute and Chronic Wounds-A Prospective, Monocentric Clinical Trial to Examine the Effect of Shock Waves on Wound Healing.

The aim of our prospective blinded clinical study was to examine a possible improvement and acceleration of epithelialization by treatment with low-energy extracorporeal shock waves on skin graft donor and recipient sites in patients with chronic wounds. In addition, several secondary parameters were investigated to evaluate the compatibility of the therapeutic method, its influence on infection occurrence and bacterial colonization. A total of 35 patients were included in the study. Of these, 25 participants were assigned to the verum-placebo group and 10 to the sham treatment group. The study of the sham control group was done to exclude a possible "remote effect" of the placebo area. Depending on the group, the wound areas were treated with low-frequency shock waves, placebo, or sham. The examinations were performed immediately on Day 0 after surgical treatment and on Days 5, 7, 9, and 12 after surgery. To record long-term results, an additional evaluation of the wound situation was performed on Day 90. Epithelialization was statistically significantly accelerated by shock wave application at both skin graft recipient sites and donor sites (0.86 vs. 0.92, p < 0.05). Furthermore, the risk of wound infection was significantly reduced by using extracorporeal shock waves. Serious side effects were not reported. A repeated application of ESWT followed by standardized wound care was shown to significantly accelerate the time to re-epithelialization at the skin graft donor and recipient site compared with re-epithelialization time in patients of the sham/placebo group.

Synergistic healing: Efficacy of extracorporeal shock wave therapy and low level laser therapy in managing plantar fasciitis heel pain: A pilot Study

Synergistic healing: Efficacy of extracorporeal shock wave therapy and low level laser therapy in managing plantar fasciitis heel pain: A pilot Study

Efficacy of platelet-rich plasma injection for pain relief in injured athletes: a systematic review of randomized controlled trials.

Sports injuries involving bi-articular muscles like the hip flexors, hamstrings, quadriceps, and gastrocnemius significantly affect athletes' performance and quality of life. Comprehensive rehabilitation is crucial for a pain-free return to play (RTP). Over the past 15 years, platelet-rich plasma (PRP) has emerged for its potential in tissue regeneration. However, the effects in pain relief and early RTP remained debated. This systematic review of randomized controlled trials (RCTs) aimed to evaluate the efficacy of PRP in pain management for injured athletes. A systematic review searched on PubMed, Scopus, and Web of Science for randomized controlled trials (RCTs) on PRP injections in injured athletes up to May 28, 2024. Studies had to meet the following population, intervention, control and outcome (PICO) criteria: professional athletes treated with leukocyte-rich or leukocyte-poor PRP versus other treatments, with pain measured by visual analogue scale (VAS), numeric rating scale (NRS), or verbal rating scale (VRS) scales. Systematic review registered on PROSPERO (CRD42024552342). Out of total of 1675 articles, we included seven RCTs on PRP treatment for muscle injuries and tendinopathies in athletes. Two studies on hamstring injuries had conflicting results on PRP's efficacy; two studies on different muscles showed significant pain relief and quicker recovery with ultrasound-guided PRP, limited by small sample sizes and lack of double-blind protocols. For tendinopathies, an anterior cruciate ligament reconstruction study with autologous bone-patellar tendon-bone grafts showed significant pain improvements but had a small sample size. Another study on patellar tendinopathy found no PRP benefits over placebo. A third study found long-term improvement with PRP over shockwave therapy for patellar tendinitis, despite design limitations. This systematic review suggested that PRP might aid in pain management for athletes, but high-quality evidence is lacking. Further research with standardized methodologies is needed to confirm the PRP efficacy, which could complement multidisciplinary rehabilitation.

Does the frequency and number of ESWT sessions in patients with heel spurs affect the final result of the therapy?

Introduction: In the literature, the effectiveness of the extracorporeal shock wave therapy (ESWT) in patients with heel spur was confirmed, but the therapy protocol has not been established when used as monotherapy. The aim of the study was to verify whether the frequency of ESWT and the number of sessions used as monotherapy in patients with heel spur have an impact on the final result of the therapy. Methods: 85 patients were divided into three subgroups. All patients were treated 5 times with different intervals between ESWT sessions, in the group I, ESWT was ad-ministered every day, in group II every other day and in the group III once a week. Results: Before starting therapy, pain level in VAS in subgroups I, II and III was 6, 7 and 9, respectively. After two weeks, the pain level was equal 4 in all subgroups. In this time, the subgroup I was one week after completing therapy, subgroup II was just after completing therapy and subgroup III after 2 out of 5 treatments. Finally, after 8 weeks, when all subgroups terminated therapy, VAS was in the range 2–3. When comparing the subgroups, with the numbers available no significant difference could be detected. Conclusion: Received results proved the effectiveness of ESWT used as monotherapy in patients with heel spur. The length of the intervals between subsequent ESWT sessions did not have a statistically significant impact on the final result of the therapy, which was at a similar level in all subgroups.

Stone-free Rate of Ultrasound-assisted and Fluoroscopy-guided Extracorporeal Shockwave Lithotripsy for Radiopaque Renal Stones

Background: Extracorporeal shock wave lithotripsy (ESWL) has been a widely accepted method for treating urinary stones since the early 1980s. ESWL is the preferred non-invasive treatment for renal stones that are smaller than 1.5 cm. Ultrasound and fluoroscopy are used during ESWL operations to visualize the fragmentation. Objective: To determine the Stone-free rate of ultrasound-assisted and fluoroscopy-guided extracorporeal shockwave lithotripsy for radiopaque renal stones. Methodology: A prospective cohort study was conducted at the Sindh Institute of Urology and Transplantation from 25th February to 25th August 2022, including 75 participants per group with renal stones &lt;1.5 cm, radio-opaque kidney stones, and consented patients. Both groups were treated using identical lithotripters with ultrasound and fluoroscopy for stone localization. Post-lithotripsy, X-ray or ultrasound assessed stone clearance. Frequency and percentages were calculated for variables like age, gender, and stone-free rates. Mean values and deviations were computed. The Chi-Square test analysed categorical variables. Paired sample statistical analysis evaluated differences in stone size and clearance, with p-values &lt;0.05 deemed statistically significant. Results: Within group A, 53 patients (70.7%) exhibited no stones, whereas in group B, 45 patients (60%) were devoid of stones. These findings suggest that group A surpassed group B in terms of achieving stone-free statuses. Conclusion: Our research findings indicate that ultrasound-assisted extracorporeal shockwave lithotripsy achieved a stone-free rate of 70.7%, surpassing the stone-free rate of 60% achieved by fluoroscopy-guided extracorporeal shockwave lithotripsy for radiopaque renal stones.

Comparison of the Effects of Extracorporeal Shockwave Therapy Application Sites on Pain, Pressure Pain Threshold, Strength, and Functional Improvement in Patients with Lateral Epicondylitis

Comparison of the Effects of Extracorporeal Shockwave Therapy Application Sites on Pain, Pressure Pain Threshold, Strength, and Functional Improvement in Patients with Lateral Epicondylitis

From diagnosis to rehabilitation of trigger finger: a narrative review.

Trigger finger (TF), also known as stenosing flexor tenosynovitis, is a common pathology of the fingers causing functional deficit of the hand. In recent years, new therapeutic approaches such as extracorporeal shock wave therapy (ESWT) and ultrasound-guided (USG) procedures have joined the most traditional conservative treatments as the adaptation of daily activities involving the affected hand and the orthosis. Likewise, the ultrasound (US) examination of the affected finger using modern high-frequency probes has progressively become part of the comprehensive assessment of patients with TF coupled with the medical history, the physical examination, and the functional scales. In this sense, considering the technological advances in both diagnostic and therapeutic fields, the non-surgical strategies have progressively grown defining a rehabilitation panel more complex than in the past. The present manuscript aims to provide an updated practical guide for clinicians and surgeons reviewing the state-of-art of both the assessment and the treatments of patients with TF to plan tailored rehabilitation management taking advantage of the matching of traditional and novel techniques.

Non-invasive rehabilitation in Morbus Ledderhose disease, methods, techniques, efficiency

The abnormal proliferation of the fibrous tissue in the plantar fascia, Morbus Ledderhose is a non-malignant thickening of the deep connective tissue of the foot, a relatively rare pa-thology that intensely affects patients through marked pain and functional impotence. Re-habilitation treatments are poorly presented in the literature. To apply a non-invasive physiotherapeutic treatment which leads to consistent results in reducing pain, reducing the size of nodules or even their disappearance, the functional resumption of the foot, an increase in the life quality of affected patients. In the study, pa-tients were divided into 2 groups: G1 received treatment consisting of shockwave therapy complemented with SIS therapy, G2 received treatment consisting of ultrasound, laser therapy, kinesiotherapy, massage, excluding the application of shockwave therapy and SIS. Some of the patients associate comorbidities such as type II diabetes, Dupuytren’s disease or, more rarely, with Peyronie’s disease (penile fibromatosis). Important positive results have been obtained: a considerable decrease in the pain level of patients, the dissi-pation of consistency and decrease in the size of plantar nodules, an increase in the life quality of the patients with the resumption of productive activities. The treat-ment with shock waves and super inductive system has an increased efficiency both folowing the first cure and after various consecutive cures applied consistently at 6 months or maybe even faster, at 4-5 months, if necessary, if the pathology advances faster by intensifying fibrosis.