Modified shockwave propulsion lithotripsy improves the lower pole renal stone clearance

The shockwave lithotripsy is an established modality for the treatment of urinary stone disease. The aim of the study was to present our modified shockwave lithotripsy (SWL) technique, a shockwave propulsion lithotripsy (SWPL) technique, for the treatment of lower pole renal stones and compare its clinical outcomes with the standard SWL technique. An evaluation of a prospectively collected database including 168 patients divided into two groups and treated with ultrasound-guided SWL (n = 80) and SWPL (n = 88) were included in our study. The data were collected between January 2016 and December 2021. Patients older than 18 years old with single lower pole stones sized up to 2 cm were included in the study. SWPL was associated with significant higher SFR compared to standard SWL (85.2 vs. 62.5%, p = 0.001) and required less applied shockwaves (2151 vs. 2502, p = 0.001). Most of the patients in both groups underwent only one SWL session. Overall, a 7.1% complication rate (12 out of 168 patients) was reported, with no difference between groups. In conclusion, our proposed SWPL technique was aimed to overcome difficulties associated with the gravity and anatomic specificities of the lower pole, increased SFR and decreased the need for additional treatment.