[Extracorporeal shock wave lithotripsy in urolithiasis. An update]

The author discusses the present role of extracorporeal shock wave treatment of urolithiasis. The views are based on personal experience and a review of the recent literature. Compared with the original device, second generation lithotriptors have led to almost painless treatment. They are less effective in fragmenting the stones, however, which implies a higher number of repeat treatments. The indications and contraindications for extracorporeal shock wave lithotripsy have remained unchanged over the last years. In principle, stones along the whole upper urinary tract can be treated. The ideal situation is a stone in the kidney pelvis less than 2.5 cm in diameter or an unimpacted stone in the upper or lower ureter, with normal collective system anatomy. The main determinants for treatment outcome are stone burden, number, location and chemical composition, presence of infection, intrarenal anatomy and fluid dynamics. Special situations often need additional treatment with other treatment modalities. Rest fragments, even less than 4 mm, are often of clinical significance within two years of treatment. Bioeffects of extracorporeal shock wave lithotripsy include anatomical and functional alterations. Usually they are resolved within weeks. The relationship between extracorporeal shock wave lithotripsy and new onset hypertension remains unresolved.