Tailly GG, 2013: Extracorporeal shock wave lithotripsy today
Department of Urology, AZ klina, Augustijnslei, Brasschaat, Belgium
Even 32 years after its first introduction shockwave lithotripsy (SWL) remains a matter of discussion and controversy. Since the first SWL in 1980, millions of treatments have been performed worldwide. To this day SWL remains the least invasive of all stone treatments and is considered the treatment modality of first choice for the majority of urinary stones. Despite the massive scale on which SWL is performed in a wide range of indications, complication rate has always remained very low and usually limited to minor side effects and complications. The introduction of affordable multifunctional lithotripters has made SWL available to more and more departments of urology worldwide. Still many centers are disappointed with the treatment results and concerned about the adverse tissue effects. In this SWL proves to be the victim of its uninvasiveness and its apparent ease of practice. Urologists need proper skill and experience; however, to adequately administer shockwaves in order to improve outcome. This aspect is too often minimized and neglected. Apart from this the power of shockwaves often is underestimated by operators of shockwave machines. Basic knowledge of the physics of shockwaves could further reduce the already minimal adverse tissue effects. Good training and coaching in the administration of shockwaves would no doubt lead to a renaissance of SWL with better treatment results and minimal adverse tissue effects.
Indian J Urol. 2013 Jul;29(3):200-7. doi: 10.4103/0970-1591.117283.
This article is a very useful review of the history of SWL; the specific features of different lithotripters and a detailed discussion of all those factors that need to be carefully considered in order get successful results with SWL. It is correctly stated that urologists need skill and experience to achieve acceptable SWL results and it is emphasized that such aspects today are both minimized and neglected. This is one of the reasons why SWL has decreased in popularity despite its non-invasive character. The messages in this article are particularly important because the author has a long and outstanding experience of SWL.