Katsimperis S. et al., 2026: . Burst wave lithotripsy: insights on effectiveness and safety.

Katsimperis S, Tonyali S, Tzelves L.
Curr Opin Urol. 2026 Mar 4. doi: 10.1097/MOU.0000000000001380

Abstract

Purpose of review: Burst wave lithotripsy (BWL) has emerged as a novel noninvasive approach for urinary stone management, aiming to overcome key limitations of conventional shock wave lithotripsy, including variable efficacy, pain, and tissue injury. This review examines the growing body of experimental and early clinical evidence evaluating BWL as a noninvasive, anesthesia-sparing option for urinary stone management.

Recent findings: Recent experimental, preclinical, and first-in-human studies demonstrate that BWL can achieve efficient stone fragmentation across a range of compositions with controllable fragment size through frequency modulation. Clinical studies report high rates of stone comminution, favorable fragment profiles, and excellent tolerability in awake patients, with predominantly low-grade adverse events. Integration with ultrasonic propulsion has further improved fragment clearance and stone-free outcomes. Preclinical data also suggest a favorable renal safety profile, including in anticoagulated models.

Summary: Current evidence supports BWL as a promising complementary technology for selected patients with renal and ureteral stones, offering truly noninvasive, patient-centered care. Ongoing trials will clarify its role within treatment algorithms and define optimal indications and workflows.

Comment Peter Alken

When I first read about BWL (Burst Wave Lithotripsy) in 2015 (1), it seemed like a glimpse of paradise. Even today, this “Promised Land” remains unchanged (2). Much like ESWL—which was renamed SWL, presumably for commercial reasons (?)—Burst Wave Lithotripsy now appears to be marketed as the “Break Wave™ System” (3). Yet, looking at this “Promised Land” today—more than a decade later—it feels more like “Neverland”;  it is difficult to comprehend why the introduction of this technology into medical practice has been delayed for so long. One is struck by an impression akin to viewing a 100-unit apartment complex: the building is fenced off and slowly falling into disrepair because a business dispute prevents it from being used for its intended purpose—and this despite the general housing shortage. BWL will come and hopefully spur further progress, as well as give established SWL companies time to develop alternatives.

1 Maxwell AD, Cunitz BW, Kreider W, et al. Fragmentation of urinary calculi in vitro by burst wave lithotripsy. J Urol 2015; 193:338–344.

2 Katsimperis S, Tonyali S, Tzelves L. Burst wave lithotripsy: insights on effectiveness and safety. Curr Opin Urol. 2026 Mar 4. doi: 10.1097/MOU.0000000000001380.

3 https://clinicaltrials.gov/study/NCT05701098

Peter Alken