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Shockwave lithotripsy: techniques for improving outcomes

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Abstract

Objectives

Shock wave lithotripsy (SWL) remains the only effective truly non-invasive treatment for nephrolithiasis. While single-treatment success rates may not equal those of ureteroscopy and percutaneous nephrolithotomy, it has an important role to play in the management of stones. In this paper, we outline the latest evidence-based recommendations for maximizing SWL outcomes, while minimizing complications.

Materials and methods

A comprehensive review of the current literature was performed regarding maximizing SWL outcomes.

Results

Several different considerations need to be made regarding patient selection with respect to body habitus, body mass index, anatomical location and underlying urologic abnormalities. Stone composition and stone density (Hounsfield Units) are important prognostic variables. Patient positioning is critical to allow for adequate stone localization with either fluoroscopy or ultrasound. Coupling should be optimized with a low viscosity gel applied to the therapy head first and patient movement should be limited. SWL energy should be increased slowly and shockwave rates of 60 or 90 Hz should be used. Medical expulsive therapy with alpha-blockers after SWL treatment has shown benefit, particularly with stones greater than 10 mm.

Conclusion

While single-treatment success rates may not equal those of ureteroscopy or percutaneous nephrolithotomy, with proper patient selection, optimization of SWL technique, and use of adjunctive treatment after SWL, success rates can be maximized while further reducing the already low rate of serious complications. SWL remains an excellent treatment option for calculi even in 2017.

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Author information

Authors and Affiliations

  1. Division of Urology, Department of Surgery, St. Michael’s Hospital, University of Toronto, Toronto, Canada

    Tadeusz Kroczak & Kenneth T. Pace

  2. Department of Urology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada

    Kymora B. Scotland & Ben Chew

Authors
  1. Tadeusz Kroczak
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  2. Kymora B. Scotland
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  3. Ben Chew
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  4. Kenneth T. Pace
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Correspondence to Kenneth T. Pace.

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Kroczak, T., Scotland, K.B., Chew, B. et al. Shockwave lithotripsy: techniques for improving outcomes. World J Urol 35, 1341–1346 (2017). https://doi.org/10.1007/s00345-017-2056-y

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  • DOI: https://doi.org/10.1007/s00345-017-2056-y

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