The role of energy density and acoustic cavitation in shock wave lithotripsy

Today a high percentage of urinary stones are successfully treated by extracorporeal shockwave lithotripsy (SWL); however, misconceptions regarding fragmentation mechanisms, as well as treatment parameters like dose, applied energy and focal area are still common. A main stone comminution mechanism during SWL is acoustic cavitation. The objective of this study was to analyze the influence of cavitation and energy density on stone fragmentation. A research lithotripter was used to expose a large set of artificial kidney stones to shock waves varying different parameters. Hundreds of pressure records were used to calculate the energy density of the lithotripter at different settings. Results indicate that energy density is a crucial parameter and that better SWL treatment outcomes could be obtained placing the calculus at a prefocal position.