Shock Wave Lithotripsy for Renal and Ureteric Stones

ObjectiveWe provide a comprehensive overview of the main aspects of shock wave lithotripsy (SWL) for renal and ureteric stones.Evidence acquisitionWe reviewed current literature, concentrating on high-quality reviews in international journals. In addition, the latest European Association of Urology guidelines and standard textbooks were consulted.Evidence synthesisSWL can treat >90% of stones in adults and has revolutionized the treatment of urolithiasis. Despite the progress of minimally invasive endourologic procedures, SWL still contributes to >50% of all stone treatments worldwide.With modern machines, stone-free rates of the initial Dornier HM3 have not been reached again. Apart from stone size, multiple predictive outcome factors like stone composition, position, and renal anatomy have been identified, and indications have been refined. Interestingly, a growing number of nonurologic indications for SWL such as stimulating re-epithelization and improving myocardial function, have been reported recently.Furthermore, treatment protocols have been optimized by lowering shock wave rate, improving coupling, applying abdominal compression, power ramping, and postoperative medical expulsion therapy. New promising developments are twin-head and tandem-pulse shock wave generators. Automated localization and acoustic tracking and feedback systems have been developed with the potential to improve stone disintegration, to limit radiation, and to avoid overtreatment and complications.ConclusionsSWL is a safe and well-established procedure that still plays an important role in the treatment of upper urinary tract stone disease. To achieve optimal results, the refined indications need to be respected and patients need to be carefully selected. Treatment protocols need to be optimized. Novel promising technical developments are upcoming, and there is growing interest in shock wave therapy from other specialties. SWL is a substantial part of urology that every urologist should learn to master during his or her training.