Extracorporeal Shock Wave Lithotripsy (ESWL) has been a cornerstone in treating pediatric urinary stones for nearly four decades, but requires tailored approaches due to anatomical and physiological differences from adults. This review synthesizes current evidence on ESWL efficacy predictors in children, integrating multicenter data and emerging technologies. Key traditional predictors include favorable stone characteristics [density ≤600 Hounsfield units [HU], size ≤15 mm, skin-to-stone distance [SSD] ≤6.6 cm, upper/middle calyx or ureteral location] and patient factors (age ≤3 years, male sex); conversely, urinary tract infections (UTIs), BMI >22, and multiple stones correlate with poorer outcomes. Innovations like dual-energy CT (DECT), AI-based models, shear wave elastography (SWE), and bioelectric impedance analysis (BIA) offer promising non-invasive preoperative assessment. We highlight the need for standardized multifactorial predictive models to optimize pediatric ESWL outcomes. Future directions emphasize AI, big data, and multidisciplinary collaboration to enhance personalized treatment and reduce complications. This analysis provides clinicians with evidence-based tools to refine pediatric ESWL protocols.

Background: Retrograde intrarenal surgery (RIRS) has become an established minimally invasive treatment for kidney stones, particularly in cases where extracorporeal shockwave lithotripsy or percutaneous nephrolithotomy are unsuitable. However, stone-free (SF) outcomes vary, and identifying preoperative factors associated with success remains essential for improving patient selection and surgical planning. Objective: To identify factors associated with SF outcomes after RIRS and to develop a simple model-based clinical decision rule using preoperative variables. Materials and Methods: The present study was a retrospective study that included 114 patients who underwent RIRS. Baseline characteristics were compared between SF and non-stone-free (non-SF) groups. All variables were screened using bivariate logistic regression, and those with significant results were included in a multivariable analysis. Model performance was evaluated using standard statistical measures, and a simple decision rule was constructed from key preoperative factors. Results: Stone diameter was independently associated with SF outcomes (AOR 0.86, 95% CI 0.76 to 0.98, p=0.024). Prior open surgery (AOR 0.09, 95% CI 0.01 to 1.21, p=0.070) and log-transformed estimated blood loss (AOR 0.29, 95% CI 0.07 to 1.11, p=0.071) showed borderline associations. The final model demonstrated good discriminative performance (AUC 0.87) and acceptable calibration (Hosmer-Lemeshow, p=0.47). A simple decision rule incorporating kidney stone diameter and surgical history stratified patients into low- and high-risk groups, with residual fragment rates of 12.0% and 33.7%, respectively. Conclusion: Preoperative factors, particularly stone diameter and prior surgical history, play a key role in SF outcomes after RIRS. A simple clinical rule based on these variables may support risk stratification and guide patient counseling in routine practice.

ABSTRACT Shock Wave Lithotripsy (SWL) is a technique for treating kidney stones. A Danish university hospital implemented a new pain management strategy focused on oral painkillers instead of intravenous opioid analgesics. This study aimed to evaluate patients' satisfaction with the new strategy during SWL and their overall treatment satisfaction. Patients were prospectively recruited in March 2020 to July 2021 and provided informed consent. A validated questionnaire was used to assess pain and satisfaction, pre‐ and post‐treatment. Demographic information, characteristics of the kidney stone, and pain treatment were also recorded. Pain was measured using the Numeric Rating Scale (NRS), and satisfaction was rated using NRS 0–10. A total of 108 patients (66% men) were included, with a mean age of 56 years (SD 14.3). Most included patients (92%) received oral painkillers (paracetamol and ibuprofen) as pre‐treatment pain relief, while 7% received sublingual fentanyl. Non‐pharmacological pain‐relieving methods, like relaxation and listening to music, were used by 64% of patients. The mean pain score during treatment was 4.9 (SD 2.9), and the median satisfaction score with pain treatment was 9 (IQR 6–10). The overall satisfaction score was 10 (IQR 8–10). 89% were highly satisfied (NRS 8–10) and willing to repeat treatment. Patients were highly satisfied with outpatient SWL and oral painkillers alone. The extensive use of non‐pharmacological pain relief suggests alternative pain management strategies should be further investigated and developed.

Cholecystectomy has traditionally been the mainstay of treatment for symptomatic gallstones; however, the complications of cholecystectomy have led to the adoption of minimally invasive gallbladder-preserving approaches in some patients. A simple but highly effective technique is currently lacking. This study aimed to evaluate the feasibility and safety of a novel endoscopic transgastric gallbladder-preserving cholecystolithotomy (GPC) for this condition. This was a single-arm prospective clinical study involving 23 patients with symptomatic gallstones enrolled between July 2018 and August 2020. All patients underwent a novel endoscopic transgastric GPC, in which we performed the cholecystogastrostomy via transgastric natural orifice translumenal endoscopic surgery (NOTES) using a gallbladder stent as the passage before advanced endoscopic cholecystolithotomy. Technical success, therapeutic efficacy, and procedure-related complications were evaluated. The technical success rate of transgastric NOTES-guided cholecystogastric stent placement was 95.7% (22/23). One case which failed due to an intraoperative finding of pericholecystic adhesions was subsequently converted to cholecystectomy. Among the 22 patients who achieved technical success, 19 underwent a simple cholecystolithotomy using a basket or balloon. In the remaining three patients, two required lithotripsy for large gallstones and the other for an incarcerated calculus using an ultraslim endoscope on retrial. All 22 patients achieved wound healing within 4 days postoperatively. Common procedure-related complications were hemorrhage and infection, all of which were mild and temporal. The overall stone recurrence rate was 9.1% at the 3-year follow-up. The novel endoscopic transgastric GPC could be a safe and effective alternative endoscopic approach for GPC.

Effect of Educational Program on Quality of Life among Patients Undergoing Extracorporeal Shock Wave Lithotripsy for Nephrolithiasis

Ultrasonography use in prediction of extracorporeal shock wave lithotripsy outcomes

In the present cross-sectional study, 100 patients who underwent ESWL (60 men and 40 women) in a public hospital during the period 2023-2024 were enrolled. The data collection was carried out via interviews using the State-Trait Anxiety Inventory (STAI) scale which included patients' characteristics. Of the 100 participants, the majority were men (60%), over 60years of age (41%) and of secondary education level (47%). The mean value of the two scores was 50.9 for state and 56.1 for trait anxiety before ESWL which indicates moderate anxiety levels. After ESWL, no statistically significant change in state and trait anxiety scores was observed (p=0.186 and p=0.387, respectively). A statistically significant association was observed between state anxiety before ESWL and gender (p=0.048), whether patients had other diseases (p=0.042), and how well they were informed about ESWL (p=0.043). Regarding trait anxiety, a statistically significant association was observed with gender (p=0.018), their profession (p=0.050), and how well they were informed about ESWL (p=0.041). In terms of trends, a statistically significant interaction was observed between time and the profession of patients (p=0.002) for the state anxiety and patients' family history of lithiasis (p=0.002) for the trait anxiety. Before ESWL, patients experience moderate anxiety (state, trait) with no statistically significant changes after. Reducing the anxiety of patients undergoing ESWL is beneficial.

Rare complication of active renal arterial hemorrhage after extracorporeal shockwave lithotripsy (ESWL) in a low-risk patient: A case report.

Background: Renal calculi are a common urological problem, and the choice between minimally invasive options depends mainly on stone size and location. Extracorporeal shock wave lithotripsy (ESWL) and micro-percutaneous nephrolithotomy (Micro-PCNL) are standard treatments for small renal stones, but their comparative efficacy remains uncertain. Objective: To compare stone clearance outcomes of ESWL and Micro-PCNL in patients with small renal calculi. Study Design: Quasi-experimental study. Settings: Department of Urology, Sir Ganga Ram Hospital, in collaboration with Jinnah Hospital, Lahore, Pakistan. Duration: 16th July 2021 to 15th August 2022. Methods: Following ethical approval, 92 patients aged 18–65 years with renal stones <1.5 cm and normal renal anatomy were enrolled through non-probability consecutive sampling and divided equally into ESWL and Micro-PCNL groups (n = 46 each). Stone-free status was assessed by X-ray KUB. Data were analyzed using the Chi-square test, with p < 0.05 considered significant. Results: Mean stone size was 14.5 ± 0.50 mm in the Micro-PCNL group and 11.8 ± 2.64 mm in the ESWL group. Stone-free rates were 63% and 65.2%, respectively (p = 0.82). However, for stones >13 mm, Micro-PCNL achieved significantly higher clearance (63%) compared to ESWL (29.4%) (p = 0.018). Conclusion: Both ESWL and Micro-PCNL are effective for small renal stones, with no significant difference in overall clearance rates. Micro-PCNL, however, provides better outcomes for stones larger than 13 mm, making it a more suitable choice for slightly larger calculi within the small-stone category.

Accurately predicting the outcome of extracorporeal shock wave lithotripsy (ESWL) is a persistent clinical challenge. While machine learning (ML) offers potential for improved predictions, the opacity of many models hinders clinical trust and adoption. This study aimed to develop and validate an interpretable ML model to predict ESWL success using routinely available clinical data. In this retrospective cohort study, we analyzed data from 1,501 patients treated with a single ESWL session at a single institution (2022-2024). Six ML algorithms were trained on 75% of the data (n=1,125), with performance evaluated on a hold-out test set (n=376). Techniques to manage significant class imbalance were employed. Model interpretability was achieved using SHapley Additive exPlanations (SHAP). The extreme gradient boosting (XGBoost) model demonstrated the best discriminative performance, with an area under the receiver operating characteristic curve (ROC-AUC) of 0.723 (95% CI: 0.662-0.784). However, a critical trade-off was observed: the model exhibited high specificity (95.2%) but low sensitivity (35.4%), meaning it identified most successes but missed nearly two-thirds of treatment failures. Stone density and size were the most influential predictors, and SHAP analysis provided clinically plausible, individualized explanations for predictions. We present a transparent, interpretable ML framework for ESWL outcome prediction. While the model aligns with clinical reasoning and offers a foundation for trustworthy artificial intelligence, its current low sensitivity limits immediate standalone clinical utility for ruling out ESWL failure. The framework highlights the imperative for future work to improve sensitivity through richer datasets and prospective validation before integration into clinical pathways.

There are few studies evaluating the burden of urolithiasis on healthcare systems in Scandinavia. This study aimed to assess national trends in hospital encounters and surgical interventions for urolithiasis in Norway. National data on hospital admissions, outpatient consultations, inpatient stays and surgical procedures were obtained from the Norwegian Directorate for Health and the Norwegian Patient Register for 2012-2023 and the operative data for 2019-2024. Variables included age and sex. Poisson regression estimated annual changes. Between 2012 and 2023, 109,490 unique patients had a hospital encounter for urolithiasis, increasing by 2.9% annually (p < 0.001). The increase was greater in males (3.2% vs. 2.6%, p < 0.001) and in those ≥70 years (6.4% vs. 2.0%, p < 0.0001). Outpatient consultations increased by 3.2% per year, with the steepest rise among older adults. Inpatient days declined annually by 2.45% (p < 0.001), while ambulatory treatments increased by 17.4% (p < 0.0001). Between 2019-2024, ureteroscopy (URS) increased from 68.6% to 80.4% of renal stone procedures and from 99% to 100% for ureteral stones. By 2024, URS accounted for 88% of all stone procedures, while shock wave lithotripsy (SWL) declined to zero for ureteral stones. Urolithiasis places an increasing burden on the Norwegian healthcare system, particularly among older adults. Surgical management in Norway favours URS, representing one of the highest national proportions reported.

To develop a machine learning model for predicting stone-free (SF) outcomes following extracorporeal shock wave lithotripsy (SWL) and to identify key clinical and stone-related predictors using interpretable machine learning techniques. A total of 369 patients who underwent SWL between 2013 and 2022 at a single institution were retrospectively analyzed. Clinical and stone-related features were used to train a Light Gradient Boosting Machine (LightGBM) classification model. The dataset was split into training (70%) and testing (30%) sets, and model performance was evaluated using accuracy, area under curve (AUC), recall, precision, and F1-score. SHapley Additive exPlanations (SHAP) values were used to assess feature importance. SMOTETomek was performed to address class imbalance. The LightGBM model achieved an overall accuracy of 82.88% and an AUC of 0.651 in the testing set. However, recall and precision for the SF group were low (18.2% and 16.7%, respectively), reflecting model bias due to class imbalance. SHAP analysis identified mean stone size, ureter stone, and stone burden as the top predictors of SWL success. After class balancing, hypertension and age were ranked among the most influential features in the model. Logistic regression confirmed the significance of mean stone size and stone location, while SHAP revealed additional nonlinear feature contributions not captured by traditional methods. The LightGBM model combined with SHAP interpretation effectively identified important predictors of SWL outcomes. Despite good overall performance, limited sensitivity for SF cases highlights the impact of class imbalance. Addressing this through balancing techniques and incorporating additional clinical variables may improve prediction and support personalized treatment planning in SWL.

Introduction: Coronary artery disease (CAD) is typically a chronic, progressive, inflammatory disease of the coronary arteries caused by coronary atherosclerosis. Moderate-to-severe calcification is present in up to 30% of patients undergoing coronary angiography (CA). Calcified coronary artery lesions are one of the most complex and challenging lesion subsets in interventional cardiology. Shockwave intravascular lithotripsy (IVL) is a recently introduced calcium-modifying technique for the treatment of concentric, eccentric and nodular calcifications. Case presentation: We present a clinical case of a 73-year-old male complaining of intermittent chest pain. He was a non-smoker with a positive familiar history for CVD. He had previous myocardial infarction and stenting of the right coronary artery (RCA), previous CVI, paroxysmal atrial fibrillation, insulin-dependent type 2 diabetes, heart failure with mildly reduced ejection fraction (HFmrEF) and chronic kidney disease (CKD) stage II/IIIa. CA revealed heavily calcified CAD. A calcified lesion of the left anterior descending artery (LAD) was treated using a 3.0/12 mm Shockwave IVL balloon; and calcium cracks and fractures were confirmed by optical coherence tomography (OCT). We proceeded with an NC balloon and finally treated the lesion with a 3.5/15 mm drug-coated balloon (DCB). The calcified lesion of the RCA was treated with conventional techniques using guiding catheter extension, NC balloons and drug-eluting stent (DES). Conclusion: Heavily calcified coronary artery lesions remain one of the biggest challenges for interventional cardiologists. Shockwave IVL is designed for treatment of all types of heavily calcified lesions using acoustic waves (shock waves). IVL is safe and effective technique that will definitely strengthen the armamentarium for modern treatment of heavily calcified lesions.

Evaluation of the Impact of Waist Circumference and Other Predictors on Shock Wave Lithotripsy Outcomes in Ureteral Calculi: A Retrospective Analysis

To compare the efficacy and safety of different treatment modalities, mini-percutaneous nephrolithotomy (mini-PNL), retrograde intrarenal surgery (RIRS), and extracorporeal shock wave lithotripsy (SWL), for the management of medium-sized, high-density, non-lower-pole renal stones. Between November 2021 and March 2025, adults with single renal stones of 10-20mm and ≥ 1000 HU were prospectively randomized to mini-PNL, RIRS, or SWL. Procedures were performed by experienced endourologists using standardized protocols. The primary outcome was stone-free rate (SFR) at 3months, defined as no residual fragments > 4mm on NCCT. Secondary outcomes included operative and fluoroscopy times, hospital stay, retreatment, perioperative complications, and treatment costs. Analyses followed the intention-to-treat principle. Of 330 enrolled patients, 304 completed the study (mini-PNL, n = 105; RIRS, n = 103; SWL, n = 96). Final SFRs were 96.2% for mini-PNL, 91.3% for RIRS, and 51.0% for SWL. Both mini-PNL and RIRS achieved significantly higher SFRs than SWL (p < 0.001), with mini-PNL demonstrating superior single-session clearance. Operative time was shortest with SWL, fluoroscopy exposure was lowest with RIRS, and hospital stay was shortest with RIRS, while SWL was performed on an outpatient basis. Overall complications were 11.4% (mini-PNL), 22.3% (RIRS), and 16.7% (SWL), with no significant differences (p = 0.109) or in high-grade events (p = 0.879). Median treatment costs per stone-free patient were 24,121 EGP for mini-PNL, 57,100 EGP for RIRS, and 23,843 EGP for SWL. In conclusion, mini-PNL and RIRS are more effective than SWL, with mini-PNL offering the best balance of efficacy and safety, and RIRS a less invasive but more costly option. ClinicalTrials.gov, TRN: NCT04856722, Registration date: 21 April 2021.

The As Low As Reasonably Achievable (ALARA) principle aims to minimize radiation exposure for patients and staff. This study evaluates ALARA's impact on patient radiation exposure and clinical outcomes in endourological procedures. This retrospective study analyzed 755 patients undergoing endourological procedures (percutaneous nephrolithotomy (PCNL), ureteroscopy (URS), shock wave lithotripsy (SWL), and JJ insertion and replacement), divided into limited- versus strict-ALARA adherence groups. We assessed radiation exposure (dose area product (DAP) and fluoroscopy time (FT)) and clinical outcomes (operative time (OT), stone free rate (SFR), complications). Significant DAP reductions were achieved with ALARA: 90.2% (PCNL), 92.9% (URS), 63.6% (SWL), 95.1% (JJ insertion), and 94.6% (JJ replacement) (all p < 0.001). FT also decreased significantly: 58.4% (PCNL), 64.7% (URS), 18.2% (SWL), 60.3% (JJ insertion), and 62.4% (JJ replacement) (all p < 0.001). In the ALARA group, median DAP values and FT were: PCNL (3440.0mGycm2, 3min17s), SWL (2620.0mGycm2, 2min26s), JJ insertion (247.0mGycm2, 26s), JJ replacement (199.5mGycm2, 19s), and URS (158.5mGycm2, 15s). Patient outcomes, including SFR and postoperative complications, did not differ between the ALARA and non-ALARA groups across all procedures. Operative time was shorter in the ALARA group for both PCNL (p = 0.042) and URS (p = 0.012). To our knowledge, this is the first multi-modality analysis linking strict ALARA adherence to exposure reduction and unchanged clinical outcomes across PCNL, URS, SWL, and stenting. Prospective, randomized trials should validate these novel results.

To evaluate patient adherence to prescribed medical therapy for urolithiasis following multidisciplinary consultation in a specialized stone clinic. A prospective survey-based study was conducted among high-risk stone formers treated at a multidisciplinary metabolic stone clinic staffed by an endourologist, nephrologists, and dietitians. Patients prescribed medical therapy were contacted by phone. After oral consent, a structured questionnaire assessing adherence and reasons for non-compliance was administered. Patients who declined or were unreachable after three attempts were excluded. A total of 100 patients were included (median age 55 years; 65% male). A family history of nephrolithiasis was reported by 57.4%. Prior interventions included ureteroscopy (URS) (74%), shock wave lithotripsy (SWL) (18%), and percutaneous nephrolithotripsy (PCNL) (15%). The most common stone type was calcium oxalate monohydrate (45.5%). Metabolic abnormalities included hypercalciuria (38.6%), hypocitraturia (34.7%), and hyperuricosuria (23.8%). Full compliance was reported by 57%, partial by 21%, and non-compliance by 22%, with a median adherence duration of 16 months among fully adherent patients. Common reasons for non-compliance included lack of understanding (28%), adverse effects (19%), and perceived lack of necessity (19%). Multivariable analysis identified higher level of education as the only significant predictor of improved adherence (OR 0.38, 95% CI: 0.18-0.78, p = 0.008). Use of specific medications was not significantly associated with the reported adherence or lack there of. Adherence rates were higher than previously reported, highlighting the benefit of a multidisciplinary approach with individualized metabolic evaluation and targeted therapy in stone-forming patients.

Pancreatic duct stones in chronic pancreatitis contribute to ductal hypertension, pain, and progressive pancreatic dysfunction. While extracorporeal shock wave lithotripsy (ESWL) and pancreatoscopy-guided lithotripsy facilitate stone fragmentation, clearing residual fragments remains challenging. We evaluated the efficacy and safety of a novel rotating basket catheter (RASEN) for endoscopic retrieval of small or fragmented stones. We retrospectively analyzed 63 patients who underwent endoscopic treatment for pancreatic duct stones between 2018 and 2025 at Nagoya City University Hospital. Patients were categorized into a conventional group (standard basket or balloon catheter, n = 32) and a novel group (RASEN catheter, n = 31). The primary outcome was complete stone clearance; secondary outcomes included adverse events and device-specific stone capture rates. In total, 74 procedures were evaluated (conventional: 39; novel: 35). The complete clearance rate was significantly higher in the novel group compared to the conventional group (82.9% vs. 53.8%, P = 0.012). Multivariable analysis identified RASEN use as the only independent predictor of complete clearance (P = 0.007). Device-specific analysis exhibited that RASEN achieved a higher complete clearance rate (82.9%) than all conventional baskets (33.3-50.0%) and retrieval balloons (8.1%). No significant differences in adverse events were observed between groups. The RASEN catheter significantly improved complete stone clearance without increasing procedural risk. Its structural design appears to facilitate retrieval of small or fragmented stones in anatomically complex ducts. These findings suggest RASEN is a promising tool in the endoscopic management of pancreatic duct stones.

A Multicenter Randomized Controlled Trial of Antimicrobial Prophylaxis to Prevent Urinary Tract Infections after Shockwave Lithotripsy for Urolithiasis: The APPEAL Trial.

Effect of foot reflexology on anxiety and physiological indices in patients undergoing extracorporeal shock wave lithotripsy: A randomized clinical trial study