Elmansy HE et al, 2016: Recent advances in lithotripsy technology and treatment strategies: A systematic review update.
Elmansy HE, Lingeman JE.
Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
INTRODUCTION: Shock wave lithotripsy (SWL) is a well - established treatment option for urolithiasis. The technology of SWL has undergone significant changes in an attempt to better optimize the results while reducing failure rates. There are some important limitations that restrict the use of SWL. In this review, we aim to place these advantages and limitations in perspective, assess the current role of SWL, and discuss recent advances in lithotripsy technology and treatment strategies.
METHODS: A comprehensive review was conducted to identify studies reporting outcomes on ESWL. We searched for literature (PubMed, Embase, Medline) that focused on the physics of shock waves, theories of stone disintegration, and studies on optimising shock wave application. Relevant articles in English published since 1980 were selected for inclusion.
RESULTS: Efficacy has been shown to vary between lithotripters. To maximize stone fragmentation and reduce failure rates, many factors can be optimized. Factors to consider in proper patient selection include skin - to - stone distance and stone size. Careful attention to the rate of shock wave administration, proper coupling of the treatment head to the patient have important influences on the success of lithotripsy.
CONCLUSION: Proper selection of patients who are expected to respond well to SWL, as well as attention to the technical aspects of the procedure are the keys to SWL success. Studies aiming to determine the mechanisms of shock wave action in stone breakage have begun to suggest new treatment strategies to improve success rates and safety.
Int J Surg. 2016 Nov 24. pii: S1743-9191(16)31106-2. doi: 10.1016/j.ijsu.2016.11.097. [Epub ahead of print]. FREE ARTICLE
I learned a new word: „Guarantor”; “… a person or corporation, that makes or gives a promise, assurance, or pledge typically relating to quality, durability, or performance” (http://www.thefreedictionary.com). James Lingeman is the guarantor of this publication.
This short review in the International Journal of Surgery carries information on ESWL which is well known to urologists. In the section on recent technical innovations and the size of the focal zone of shock wave generators they state “Currently, the evidence indicates that a wide focal zone provides more efficient fragmentation [48,49], while high peak pressures (i.e. high energy flux densities) result in increased tissue injury .”
I wonder why they quote rather old references  B. Granz, G. Köhler, What makes a shock wave efficient in lithotripsy, J. Stone Dis. 4 (1992) 123e128,  W. Eisenmenger, The mechanisms of stone fragmentation in ESWL, Ultrasound Med. Biol. 27 (2001) 683e693,  T. Bergsdorf, S. Thüroff, C. Chaussy, The isolated perfused kidney: an in vitro test system for evaluation of renal tissue by higheenergy shockwave sources, J. Endourol. 19 (2005) 883e888,
and did not mention or discuss the more recent paper: Lithotripter Outcomes in a Community Practice Setting: Comparison of an Electromagnetic and an Electrohydraulic Lithotripter by Bhojani N et al. and J Lingeman as senior author (J Urol. 2015; 193(3): 875–879) which is freely accessible on PubMed. In that study the small focus Modulith® SLX electromagnetic lithotripter (Storz Medical) achieved slightly better results than the wide focus LithoGold LG-380 electrohydraulic lithotripter (TRT, Woodstock, Georgia).