Bhojani N et al, 2013: Shockwave lithotripsy-new concepts and optimizing treatment parameters
Bhojani N, Lingeman JE
Department of Urology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
Stone radiodensity and skin to stone distance can both be used to optimize extracorporeal shock wave lithotripsy (ESWL) outcomes. The importance of acoustic coupling cannot be overemphasized. Air pockets within coupling gel can significantly reduce ESWL efficiency. ESWL outcomes are maximized using a frequency of 60 shock waves per minute compared with 120 shock waves per minute. Power ramping with a brief pause can not only improve ESWL stone fragmentation outcomes but also decrease renal tissue injury. Lithotripters with larger focal zones have superior stone fragmentation rates along with better renal safety profiles. Improved acoustic feedback and stone monitoring systems, as well as residual stone fragment clearance techniques, are being developed that will further improve the stone fragmentation outcomes of ESWL.
Urol Clin North Am. 2013 Feb;40(1):59-66. doi: 10.1016/j.ucl.2012.09.001. Epub 2012 Oct 18
PMID:23177635 [PubMed - indexed for MEDLINE]