Burst wave lithotripsy - a paradigm shift: inferences from a scoping review

Area of Science:

• Urology
• Biomedical Engineering
• Medical Devices

Background:

• Urolithiasis affects 10% of the global population, with Shock Wave Lithotripsy (SWL) and endoscopic methods as primary treatments.
• SWL can cause tissue injury, necessitate anesthesia, and require multiple sessions for stone clearance.
• Burst Wave Lithotripsy (BWL) presents a novel approach using lower-pressure ultrasound bursts for stone fragmentation.

Purpose of the Study:

• To evaluate the efficacy, safety, and clinical potential of Burst Wave Lithotripsy (BWL).
• To compare BWL with existing treatments like SWL for urolithiasis management.

Main Methods:

• A scoping review of 19 studies was conducted.
• Included studies encompassed in vitro experiments, preclinical trials (porcine models), and human clinical trials.
• Systematic literature search to identify eligible research on BWL.

Main Results:

• In vitro studies confirmed BWL's ability to fragment diverse stone compositions with high efficacy.
• Preclinical and human trials demonstrated BWL's safety, showing reduced tissue injury and high tolerance in awake patients (88-91% fragmentation success).
• BWL offers advantages like controlled fragmentation, lower cavitation, portability, and anesthesia-free application.

Conclusions:

• BWL represents a paradigm shift in lithotripsy, offering controlled fragmentation and reduced tissue injury.
• Early evidence suggests BWL is safe and effective, even for anticoagulated patients.
• BWL's flexibility positions it as a transformative alternative to SWL for urolithiasis management.