Shock wave lithotripsy: Advances in technology and technique

James E. Lingéman, James A. McAteer, Ehud Gnessin, Andrew P. Evan

Research output: Contribution to journalReview article

120 Scopus citations

Abstract

Shock wave lithotripsy (SWL) is the only noninvasive method for stone removal. Once considered as a primary option for the treatment of virtually all stones, SWL is now recognized to have important limitations that restrict its use. In particular, the effectiveness of SWL is severely limited by stone burden, and treatment with shock waves carries the risk of acute injury with the potential for long-term adverse effects. Research aiming to characterize the renal response to shock waves and to determine the mechanisms of shock wave action in stone breakage and renal injury has begun to suggest new treatment strategies to improve success rates and safety. Urologists can achieve better outcomes by treating at slower shock wave rate using a step-wise protocol. The aim is to achieve stone comminution using as few shock waves and at as low a power level as possible. Important challenges remain, including the need to improve acoustic coupling, enhance stone targeting, better determine when stone breakage is complete, and minimize the occurrence of residual stone fragments. New technologies have bégun to address many of these issues, and hold considerable promise for the future.

Original languageEnglish (US)
Pages (from-to)660-670
Number of pages11
JournalNature Reviews Urology
Volume6
Issue number12
DOIs
StatePublished - Dec 1 2009

ASJC Scopus subject areas

  • Urology

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