Semins MJ et al, 2015: Strategies to optimize shock wave lithotripsy outcome: Patient selection and treatment parameters.
Semins MJ, Matlaga BR.
Michelle Jo Semins, University of Pittsurgh Medical Center, Pittsburgh, PA 15213, United States.
Abstract
Shock wave lithotripsy (SWL) was introduced in 1980, modernizing the treatment of upper urinary tract stones, and quickly became the most commonly utilized technique to treat kidney stones. Over the past 5-10 years, however, use of SWL has been declining because it is not as reliably effective as more modern technology. SWL success rates vary considerably and there is abundant literature predicting outcome based on patient- and stone-specific parameters. Herein we discuss the ways to optimize SWL outcomes by reviewing proper patient selection utilizing stone characteristics and patient features. Stone size, number, location, density, composition, and patient body habitus and renal anatomy are all discussed. We also review the technical parameters during SWL that can be controlled to improve results further, including type of anesthesia, coupling, shock wave rate, focal zones, pressures, and active monitoring. Following these basic principles and selection criteria will help maximize success rate.
World J Nephrol. 2015 May 6;4(2):230-4. doi: 10.5527/wjn.v4.i2.230. Review. FREE ARTICLE
Comments 1
The authors emphasize important points that need to be considered when SWL is applied: strict control of treatment parameters in addition to appropriate patient selection.
General anaesthesia is mentioned as one way to improve the result by increasing the hit-rate. Such a step might to some extent improve the result, but also during general anaesthesia the kidney is subject to reparatory movements. Moreover, the need of anaesthesia eliminates one of the major advantages of modern SWL.
The statement that the success during recent years has decreased is a serious and depressing conclusion that, however, to a very large extent can be explained by insufficient education and training of SWL operators.