Optimizing the fragmentation and clearance after shock wave lithotripsy

Shock wave lithotripsy is the treatment of choice for small renal and upper ureteric stones. This review examines the factors that improve fragmentation and clearance of stones, and recent advances in this area.

Several randomized trials published recently have demonstrated the role of tamsulosin in helping the clearance of ureteric fragments after shock wave lithotripsy. The role of slow shock wave delivery rate has been well established. Percussion, diuresis and inversion have been used to improve results in lower calyceal stones. Few clinical studies have explored the role of position during treatment. The effects of progressive increase of lithotripter output have been demonstrated only in experimental studies.

Tamsulosin can be used to increase clearance, and reduce episodes of ureteric colic and the need for analgesics after shock wave lithotripsy. Shock waves at slow rate improve both the safety and efficacy of shock wave lithotripsy. Percussion, diuresis and inversion augments clearance of lower calyceal fragments.