Extracorporeal Shock Wave Lithotripsy (ESWL)
Shock wave lithotripsy, unlike some of the other surgical approaches we have as urologists, is more of a “black box” - Brian R Matlaga MD
HWN Suggests
Time to Retire Lithotripsy for Kidney Stones?
More than 30 years ago, extracorporeal shock wave lithotripsy (ESWL) had a highly anticipated, much-ballyhooed introduction as a nonsurgical therapy for kidney stones. Obviating the need to cut the skin or insert a device into the body, ESWL would use acoustic shock waves to pulverize stones into dust that would be washed out of the kidneys. Things didn't quite work out as planned. Over the years, the technology has "improved," yet recent results with ESWL often have yielded outcomes worse than those achieved when the treatment was first introduced.
Articles of Interest
Blasting of Kidney Stones Has Risks, Study Reports
The use of shock waves to pulverize kidney stones into sand-like material significantly increases the risk for diabetes and high blood pressure later in life, according to the longest follow-up study of the popular therapy.
Controversies in Urology: Shock Wave Lithotripsy Should Be Retired
Dr. Clayman summarized the discussion by noting that SWL is not an “on-or-off” switch. Over the years, SWL usage dropped from 70% to 30%, but this depends on how we train our urologists today. The future of SWL is dependent on the re-invention of SWL and on retraining our future urologists.
Extracorporeal shock wave lithotripsy versus flexible ureterorenoscopy in the treatment of untreated renal calculi
Treatment success was mainly dependent on stone size and treatment modality. URS might be the better treatment option for previously untreated kidney stones 5–20 mm, with similar morbidity but higher stone-free rates and fewer reinterventions than ESWL.
Non-invasive lithotripsy leads to more treatment for kidney stones
Within 120 days of the initial procedure, approximately one in five of the patients needed a second treatment. The researchers focused their comparison on patients who were equally qualified for either procedure. Among that group, 11 percent of patients undergoing shock wave lithotripsy needed a second procedure, while less than 1 percent of ureteroscopy patients needed an additional treatment.
Recent Advances in the Science of Burst Wave Lithotripsy and Ultrasonic Propulsion
Nephrolithiasis is a common, painful condition that requires surgery in many patients whose stones do not pass spontaneously. Recent technologic advances have enabled the use of ultrasonic propulsion to reposition stones within the urinary tract, either to relieve symptoms or facilitate treatment. Burst wave lithotripsy (BWL) has emerged as a noninvasive technique to fragment stones in awake patients without significant pain or renal injury.
Resources
National Kidney Foundation
Shock Wave Lithotripsy (SWL) is the most common treatment for kidney stones in the U.S. Shock waves from outside the body are targeted at a kidney stone causing the stone to fragment. The stones are broken into tiny pieces. lt is sometimes called ESWL: Extracorporeal Shock Wave Lithotripsy®.
Shockwave lithotripsy (ESWL)
The advantage of this treatment approach is that instruments may not need to be introduced into your body (unless your stone is large, in which case a stent is usually placed at the time of surgery).
