Aspects on how extracorporeal shockwave lithotripsy should be carried out in order to be maximally effective

The present review summarizes the most important considerations and steps for an optimal result of extracorporeal shockwave lithotripsy. The relationship between shockwave path, geometry and anatomical conditions is of utmost importance. Selection of appropriate treatment variables in terms of shockwave number, power and frequency, is an important prerequisite for proper disintegration and prevention of complications. Several supportive measures such as inversion therapy, citrate therapy, high diuresis, α-receptor antagonists, chemolysis and recurrence preventive measures are important parts of the management of this group of patients in order to avoid problems with residual fragments and new stone formation. Proper understanding of these factors as well as of the physics of shockwaves is necessary for a successful application of this non-invasive technology treatment concept.