Neisius A et al, 2014: Shock wave lithotripsy: The new phoenix?
Neisius A, Lipkin ME, Rassweiler JJ, Zhong P, Preminger GM, Knoll T
Department of Urology, Universitätsmedizin Mainz, Johannes Gutenberg University, Langenbeckstrasse 1, Mainz, Germany.
INTRODUCTION: Following its introduction in 1980, shock wave lithotripsy (SWL) rapidly emerged as the first-line treatment for the majority of patients with urolithiasis. Millions of SWL therapies have since been performed worldwide, and nowadays, SWL still remains to
be the least invasive therapy modality for urinary stones. During the last three decades, SWL technology has advanced in terms of shock wave generation, focusing, patient coupling and stone localization. The implementation of multifunctional lithotripters has made SWL
available to urology departments worldwide. Indications for SWL have evolved as well. Although endoscopic treatment techniques have improved significantly and seem to take the lead in stone therapy in the western countries due to high stone-free rates, SWL continues to be considered as the first-line therapy for the treatment of most intra-renal stones and many ureteral stones. METHODS: This paper reviews the fundamentals of SWL physics to facilitate a better understanding about how a lithotripter works and should be best utilized. RESULTS: Advances in lithotripsy technology such as shock wave generation and focusing, advances in stone localization (imaging), different energy source concepts and coupling modalities are presented. Furthermore adjuncts to improve the efficacy of SWL including different treatment strategies are reviewed. CONCLUSION: If urologists make use of a more comprehensive understanding of the pathophysiology and physics of shock waves, much better results could be achieved in the future. This may lead to a renaissance and encourage SWL as first-line therapy for urolithiasis in times of rapid progress in endoscopic treatment modalities.
World J Urol. 2014 Aug 1. [Epub ahead of print]
In this review of shockwave technology a lot can be learnt for every urologist. Both the present technique and possible future technological improvements of SWL are described and discussed. This article is a perfect reminder of the advantages of non-invasive stone removal with its low rate of complications. The report brings a clear message to the reader of the advantages of SWL at a time characterized by unlimited enthusiasm for endourological procedures.
Success with SWL requires a good and efficient lithotripter as well as careful attention to a number of factors necessary for optimal stone disintegration. But as with all other “surgical procedures” also SWL will fail without a definite level of experience. The multimodality asked for by lithotripter buyers is doubtful, because when the device, installed in the operating theatre, is used for URS, RIRS and PNL it cannot be used for SWL and with the ensuing limited experience of SWL, the results will become less good than expected. Moreover, the economic and other advantages of non-invasive stone removal cannot be fully utilized.
Numerous reports in the literature emphasize differences in stone-free rates between SWL and various endoscopic procedures, but very little attention seems to be paid to the benefits of SWL: non-invasiveness, non-anaesthesia requiring outpatient procedure with low rates of side effects and complications. This is in reality a low-cost treatment. If the low-invasive concept, moreover, is combined with inversion therapy, medical supported fragment elimination and recurrence preventive measures, considerably more space will be left in the operating theatres for procedures that always definitely require invasive surgery.