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SWL: our twenty-four year experience.

Giampaolo Zanetti1, Alberto Trinchieri, Emanuele Montanari

  • 1Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Clinica Urologica I Università degli Studi di Milano, Italy. gp.zanetti@tiscali.it

Archivio Italiano Di Urologia, Andrologia : Organo Ufficiale [Di] Societa Italiana Di Ecografia Urologica E Nefrologica
|June 7, 2008
PubMed
Summary

Extracorporeal shock wave lithotripsy (SWL) is safe and effective for kidney and ureteral stones. While dysrhythmias are rare and not clinically significant, close follow-up is needed for residual fragments.

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Area of Science:

  • Urology
  • Nephrology
  • Medical Technology

Background:

  • Extracorporeal shock wave lithotripsy (SWL) has been a cornerstone treatment for renal and ureteral stones for over two decades.
  • Technological advancements have led to the development of multiple generations of lithotripters, improving safety and efficacy.

Purpose of the Study:

  • To review a 24-year experience with SWL for renal and ureteral stones.
  • To evaluate the safety, efficacy, and long-term outcomes of SWL, including dysrhythmia occurrence and stone-free rates.

Main Methods:

  • Retrospective review of patient data from January 1985 onwards, utilizing various generations of Dornier lithotripters.
  • Analysis of dysrhythmia occurrence, stone clearance, fragment passage, and long-term outcomes including recurrence and regrowth.

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  • Follow-up averaged 42 months, with specific attention to clinically insignificant residual fragments (CIRF).

    • Main Results:

    • Dysrhythmias were infrequent, primarily associated with kidney treatments, and not clinically significant, even without ECG triggering.
    • Stone-free rates at discharge were 31.5%, increasing to 64.8% at 3 months and 55% after 24 months.
    • While most CIRF (less than 5 mm) pass spontaneously, approximately 20% of patients become symptomatic, necessitating close monitoring or intervention.

    Conclusions:

    • SWL remains a primary treatment for renal and ureteral stones, demonstrating long-term safety and effectiveness.
    • Careful patient and stone evaluation is crucial, and while CIRF often pass, a significant minority require follow-up or intervention.
    • Long-term monitoring is essential to manage potential complications and recurrence associated with residual fragments after SWL.