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Large T. et al., 2019: Emerging Technologies in Lithotripsy

Large T, Krambeck AE.
Department of Urology, Indiana University, Methodist Hospital, 1801 Senate Boulevard, Suite 220, Indianapolis, IN 46202, USA.

Abstract

This comprehensive review updates the advances in extracorporeal lithotripsy, including improvements in external shockwave lithotripsy and innovations in ultrasound based lithotripsy, such as burst wave lithotripsy, ultrasonic propulsion, and histotripsy. Advances in endoscopic technology and training have changed the surgical approach to nephrolithiasis; however, improvements and innovations in extracorporeal lithotripsy maintain its status as an excellent option in appropriately selected patients.

Urol Clin North Am. 2019 May;46(2):215-223. doi: 10.1016/j.ucl.2018.12.012. Epub 2019 Mar 4. Review.

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Комментарии 1

Hans-Göran Tiselius в 04.11.2019 08:55

There are essentially two factors that are responsible for the increased popularity of endourological procedures compared with SWL. The common need of repeated treatment sessions and the occurrence of residual fragments to a significant extent have cast a shadow over the flavour of non-invasive SWL.

The question frequently raised is why, in comparison with the endourological technology, so little progress can be discerned for SWL.

The authors of this report have many years experience of SWL and in this article they give an excellent review of the development of SWL technology and methods. The importance of type of shockwave generator, coupling, ramping and frequency of shockwave delivery is emphasized. These are aspects that have been discussed repeatedly in the literature during recent years.

Most interesting is, however, what we can expect from the future in order to improve stone disintegration and reduce the presence of residual fragments. Burst wave lithotripsy has shown the potential to improve stone disintegration in vitro and interestingly this effect was demonstrated for all types of stones including those composed of cystine. The combination of burst lithotripsy with US propulsion is indeed exciting and it will be highly interesting to see what can be obtained clinically with these two methods. The authors also touch histotripsy and micro bubble lithotripsy as possible ways to improve disintegration.

There is accordingly good hope that one or several technical innovations can maintain or hopefully increase the attraction of the only non-invasive surgical procedure that we have.

It needs to be emphasized, however, that also without these latter technical developments a lot can be made to achieve a high quality with SWL in its present form.

There are essentially two factors that are responsible for the increased popularity of endourological procedures compared with SWL. The common need of repeated treatment sessions and the occurrence of residual fragments to a significant extent have cast a shadow over the flavour of non-invasive SWL. The question frequently raised is why, in comparison with the endourological technology, so little progress can be discerned for SWL. The authors of this report have many years experience of SWL and in this article they give an excellent review of the development of SWL technology and methods. The importance of type of shockwave generator, coupling, ramping and frequency of shockwave delivery is emphasized. These are aspects that have been discussed repeatedly in the literature during recent years. Most interesting is, however, what we can expect from the future in order to improve stone disintegration and reduce the presence of residual fragments. Burst wave lithotripsy has shown the potential to improve stone disintegration in vitro and interestingly this effect was demonstrated for all types of stones including those composed of cystine. The combination of burst lithotripsy with US propulsion is indeed exciting and it will be highly interesting to see what can be obtained clinically with these two methods. The authors also touch histotripsy and micro bubble lithotripsy as possible ways to improve disintegration. There is accordingly good hope that one or several technical innovations can maintain or hopefully increase the attraction of the only non-invasive surgical procedure that we have. It needs to be emphasized, however, that also without these latter technical developments a lot can be made to achieve a high quality with SWL in its present form.
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