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Extracorporeal shockwave lithotripsy for upper tract urolithiasis

Weaver, Jack; Monga, Manoj

doi: 10.1097/MOU.0000000000000024
UROLITHIASIS: Edited by Mahesh Desai

Purpose of review: For the last three decades, extracorporeal shockwave lithotripsy (SWL) has been the mainstay of management of urolithiasis; recognized widely by patients and physicians for its noninvasive approach and good outcomes. Recent challenges by endoscopic approaches have driven ongoing research to refine indications, define outcomes and explore innovations.

Recent findings: Utilization of SWL remains high, despite increasing utilization of endoscopic approaches. Patient selection is critical – outcomes with percutaneous nephrolithotomy and ureteroscopy after failed SWL are not as good as those obtained in patients who have not had prior SWL. A structured training in ultrasound localization and proper patient positioning can have dramatic impacts on stone-free results. Stone size, location, Hounsfield unit stone attenuation and stone volume remain important predictors of outcomes. Renal cysts may negatively impact outcomes with SWL.

Summary: These recent studies highlight important considerations for patient selection, SWL technique and follow-up for patients undergoing SWL. New technologies hold promise but require further study.

Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, Ohio, USA

Correspondence to Manoj Monga, MD, 9500 Euclid Avenue/Q10, Cleveland, OH 44195, USA. Tel: +1 216 445 8678; fax: +1 216 636 0770; e-mail: endourol@yahoo.com

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins