Extracorporeal Shock Wave Lithotripsy: What All Urologists Should Know

  • Timothy C. K. Ng
  • Anthony C. F. NgEmail author


Despite having been used in urology for more than 30 years, there is continuous modification in the application of extracorporeal shock wave lithotripsy (ESWL) to improve its performance. For machine design, the increase in the understanding of coupling in shock wave transmission has led to the incorporation of semi-water basin or the use of camera to improve coupling during lithotripsy. The increase in usage of computerized tomography for stone diagnosis has also allowed us to collect more stone information, including stone density, skin to stone distance, etc., for the prediction of treatment outcomes. As older patients have poorer treatment outcome, and alternate treatment for senior patients should be consider if there are also other unfavorable factors. The use of better analgesic protocol, slower shock wave delivery rate, careful application of coupling gel, and closer monitoring of treatment with imaging will all contribute to improvement in treatment outcome.


Extracorporeal shock wave lithotripsy Urolithiasis Treatment protocol Outcomes Complications 


  1. Abdel-Khalek M, Sheir KZ, Mokhtar AA, Eraky I, Kenawy M, Bazeed M. Prediction of success rate after extracorporeal shock-wave lithotripsy of renal stones—a multivariate analysis model. Scand J Urol Nephrol. 2004;38(2):161–7.CrossRefGoogle Scholar
  2. Abe T, Akakura K, Kawaguchi M, Ueda T, Ichikawa T, Ito H, et al. Outcomes of shockwave lithotripsy for upper urinary-tract stones: a large-scale study at a single institution. J Endourol. 2005;19(7):768–73.CrossRefGoogle Scholar
  3. Bohris C, Roosen A, Dickmann M, Hocaoglu Y, Sandner S, Bader M, Stief CG, Walther S. Monitoring the coupling of the lithotripter therapy head with skin during routine shock wave lithotripsy with a surveillance camera. J Urol. 2012;187:157–63.CrossRefGoogle Scholar
  4. Chaussy C, Brendel W, Schmiedt E. Extracorporeally induced destruction of kidney stones by shock waves. Lancet. 1980;2(8207):1265–8.CrossRefGoogle Scholar
  5. Cleveland RO, Anglade R, Babayan RK. Effect of stone motion on in vitro comminution efficiency of Storz Modulith SLX. J Endourol. 2004;18:629–33.CrossRefGoogle Scholar
  6. El Nahas AR, El Assmy AM, Mansour O, Sheir KZ. A prospective multivariate analysis of factors predicting stone disintegration by extracorporeal shock wave lithotripsy: the value of high-resolution noncontrast computed tomography. Eur Urol. 2007;51(6):1688–93.CrossRefGoogle Scholar
  7. Elmansy HE, Lingeman JE. Recent advances in lithotripsy technology and treatment strategies: a systematic review update. Int J Surg. 2016;36:676–80.CrossRefGoogle Scholar
  8. European Association of Urology. Guidelines on urolithiasis. 2017.Google Scholar
  9. Gerber R, Studer UE, Danuser H. Is newer always better? A comparative study of 3 lithotriptor generations. J Urol. 2005;173(6):2013–6.CrossRefGoogle Scholar
  10. Hollingsworth JM, Rogers MA, Kaufman SR, et al. Medical therapy to facilitate urinary stone passage: a meta-analysis. Lancet. 2006;368:1171–9.CrossRefGoogle Scholar
  11. Li K, Lin T, Zhang C, et al. Optimal frequency of shock wave lithotripsy in urolithiasis treatment: a systematic review and meta-analysis of randomized controlled trials. J Urol. 2013;190:1260–7.CrossRefGoogle Scholar
  12. Lingeman JE, Siegel YI, Steele B, Nyhuis AW, Woods JR. Management of lower pole nephrolithiasis: a critical analysis. J Urol. 1994;151(3):663–7.CrossRefGoogle Scholar
  13. Logarakis NF, Jewett MA, Luymes J, et al. Variation in clinical outcome following shock wave lithotripsy. J Urol. 2000;163:721–5.CrossRefGoogle Scholar
  14. Neucks JS, Pishchalnikov YA, Zancanaro AJ, et al. Improved acoustic coupling for shock wave lithotripsy. Urol Res. 2008;36:61–6.CrossRefGoogle Scholar
  15. Ng CF, Lo A, Lee K, Wong KT, Chung WY, Gohel D. A prospective randomized study on the clinical effects of shockwave delivery for unilateral kidney stone: 60 versus 120 shocks per minute. J Urol. 2012;188(3):837–42.CrossRefGoogle Scholar
  16. Ng CF, Luke S, Chiu PK, Teoh JY, Wong KT, Hou SS. The effect of renal cortical thickness on the treatment outcomes of kidney stones treated with shockwave lithotripsy. Korean J Urol. 2015;56(5):379–85.CrossRefGoogle Scholar
  17. Ng CF, Siu WYD, Wong A, Goggins W, Chan E, Wong 364 KT. Development of a scoring system from non-contrast comput- 365 erized tomogram measurements to improve the selection of upper 366 ureteral stone for extracorporeal shock wave lithotripsy. J Urol. 367 2009;181(3):1151–7.Google Scholar
  18. Ng CF, Thompson T, Tolley DA. Characteristics and treatment outcome of patients requiring additional intravenous analgesia during extracorporeal shockwave lithotripsy with Dornier Compact Delta lithotriptor. Int Urol Nephrol. 2007;39:731–5.CrossRefGoogle Scholar
  19. Ng CF, Wong A, Tolley DA. Is extracorporeal shock wave lithotripsy the preferred treatment option for elderly patients with urinary stone? A multivariate analysis of the effect of patient age on treatment outcome. BJU Int. 2007;100:392–5.CrossRefGoogle Scholar
  20. Ng CF, Wong A, Tolley DA. Assessment of caliceal pelvic height is an unreliable predictor of outcome following shock wave lithotripsy. J Endourol. 2008;22(7):1409–15.CrossRefGoogle Scholar
  21. Pareek G, Hedican SP, Lee FT Jr, Nakada SY. Shock wave lithotripsy success determined by skin-to-stone distance on computed tomography. Urology. 2005;66(5):941–4.CrossRefGoogle Scholar
  22. Pickard R, Starr K, MacLennan G, Lam T, Thomas R, Burr J, McPherson G, McDonald A, Anson K, N'Dow J, Burgess N, Clark T, Kilonzo M, Gillies K, Shearer K, Boachie C, Cameron S, Norrie J, McClinton S. Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial. Lancet. 2015;386(9991):341–9.CrossRefGoogle Scholar
  23. Pishchalnikov YA, Neucks JS, VonDerHaar RJ, Pishchalnikova IV, Williams JC Jr, McAteer JA. Air pockets trapped during routine coupling in dry head lithotripsy can significantly decrease the delivery of shock wave energy. J Urol. 2006;176:2706–10.CrossRefGoogle Scholar
  24. Sorensen C, Chandhoke P, Moore M, et al. Comparison of intravenous sedation versus general anesthesia on the efficacy of the Doli 50 lithotriptor. JUrol. 2002;168:35–7.Google Scholar
  25. Tran TY, McGillen K, Cone EB, Pareek G. Triple D Score is a reportable predictor of shockwave lithotripsy stone-free rates. J Endourol. 2015;29:226.CrossRefGoogle Scholar
  26. Zheng S, Liu LR, Yuan HC, Wei Q. Tamsulosin as adjunctive treatment after shockwave lithotripsy in patients with upper urinary tract stones: a systematic review and meta-analysis. Scand J Urol Nephrol. 2010;44(6):425–32.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Division of Urology, Department of SurgeryUnited Christian HospitalKwun TongHong Kong
  2. 2.Department of Surgery, S. H. Ho Urology CentrePrince of Wales Hospital, The Chinese University of Hong KongShatinHong Kong

Personalised recommendations