Pilar Bahilo-Mateu et al., 2024: Extracorporeal shockwave lithotripsy in the management of urinary stones: New concepts and techniques to improve outcomes
Pilar Bahilo-Mateu 1 , Alberto Budia-Alba 1 2
1Lithotripsy and Endourology Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.
2Lithotripsy and Endourology Unit, Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
Abstract
Objective: Extracorporeal shockwave lithotripsy (SWL) currently plays an important role in the treatment of urinary tract lithiasis. The purpose of this article was to describe new concepts and procedural strategies that would improve results using SWL as a treatment for urolithiasis, thereby achieving better clinical practice.
Methods: A systematic review process was carried in PubMed/PMC from January 2003 to March 2023. A narrative synthesis of the most important aspects has been made.
Results: The important recommendations for the adequate selection of the candidate patient for treatment with SWL are summarized, as well as the new strategies for a better application of the technique. Aspects about intraoperative position, stone localization and monitoring, analgesic control, machine and energy settings, and measures aiming at reduced risk of complications are described.
Conclusion: To achieve the therapeutic goal of efficient stone disintegration without increasing the risk of complications, it is necessary to make an adequate selection of patients and to pay special attention to several important factors in the application of treatment. Technological development in later generation devices will help to improve current SWL results.
Asian J Urol. 2024 Apr;11(2):143-148. doi: 10.1016/j.ajur.2024.02.002. Epub 2024 Feb 7.
PMID: 38680578 PMCID: PMC11053317
Comments 1
The authors have published a review article on how SWL should be carried out with the specific title “New concepts and techniques to improve outcomes”. It is claimed that the recommendations were obtained based on a systematic review process in PubMed, 2003-2023. It thereby is interesting to note that the different recommendations, selection of patients and treatment methods are almost identical with what already was published and based on considerable personal experience, although without appropriate citation [1-3]. No new aspects on how to optimize SWL are added in the review.
The exclusion of COM stones would result in a significant reduction of patients suitable for SWL and is not necessary.
It is mentioned in the Introduction that “…contraindications for the use of SWL in certain patients, as well as its complications, prompted the appearance of endourological techniques.” This is only partly a correct description because in the early days of SWL it was considered impossible to access ureteral stones with the Dornier HM3 device. Moreover, was there an upper size limit for successful SWL of stones in the kidney [4-5]. This limit has decreased with modern lithotripsy. Accordingly, ureteroscopy was the initial solution for shortcomings regarding ureteral stones [6-8] and percutaneous surgery for large stones in the kidney [9-10]. That endourological solutions subsequently have been commonly applied instead of SWL, to some extent, is the result of unrealistic expectations by urologists on pain-free SWL. This has forced manufacturers of lithotripters to construct and deliver devices with lower capacity than ideally should be the case and undoubtedly, modern lithotripters are less powerful than the HM3 device.
In terms of new research, burst wave lithotripsy is mentioned and so are the authors’ own experiments on ultrasonic vertex beams, but without adding any results.
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Hans-Göran Tiselius