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Complications of Shock Wave Lithotripsy

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Surgical Management of Urolithiasis

Abstract

Shockwave lithotripsy (SWL) was introduced to clinical urologic practice in the 1980s with Dornier’s HM3 lithotripter and has become a common first-line treatment modality for urolithiasis (Chaussy et al., J Urol 127:417–20, 1982). Initial SWL results were promising, and since that time, SWL has become the most commonly performed treatment for renal and ureteral stones (Chaussy and Fuchs, J Urol 92:339–43, 1986; Pearle, J Urol 173:848–57, 2005).

As SWL is a noninvasive therapeutic modality, it initially was perceived as harmless to the kidney and surrounding organs (Chaussy and Fuchs, J Urol 92:339–43, 1986). However, multiple studies since that early experience have suggested or demonstrated deleterious effects of the repetitive shock waves required for successful stone fragmentation. These include acute injury to the kidney and other adjacent structures including the pancreas, colon, liver, spleen, pleura, and large blood vessels (McAteer and Evan, Semin Nephrol 28:200–13, 2008). Although SWL is generally well tolerated, it is imperative for practicing clinicians to be aware of the potential complications of this procedure.

Current SWL requires the appropriate selection of a limited number of parameters for each patient, including number of shocks delivered, shock rate, and power. However, safe application of SWL therapy must include appropriate patient selection with attention to comorbid medical conditions, stone location, size, and composition. Some complications may arise only in patients or stones that are inappropriately selected for SWL therapy. This chapter focuses on the possible complications of SWL, as well as techniques to optimize patient outcomes, while decreasing the risk for complications.

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  1. Department of Urology, Mayo Clinic Rochester, Rochester, MN, USA

    Mitra R. de Cógáin M.D. & Amy E. Krambeck M.D.

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  1. Mitra R. de Cógáin M.D.
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  2. Amy E. Krambeck M.D.
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Correspondence to Mitra R. de Cógáin M.D. .

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  1. School of Medicine and Public Health, Department of Urology, University of Wisconsin, 1685 Highland Avenue, Madison, 53705, Wisconsin, USA

    Stephen Y. Nakada

  2. Southwestern Medical Center, Department of Urology, University of Texas, 5323 Harry Hines, Blvd, Dallas, 75390, Texas, USA

    Margaret S. Pearle

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de Cógáin, M.R., Krambeck, A.E. (2013). Complications of Shock Wave Lithotripsy. In: Nakada, S., Pearle, M. (eds) Surgical Management of Urolithiasis. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6937-7_14

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  • DOI: https://doi.org/10.1007/978-1-4614-6937-7_14

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