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[Extracorporeal shock wave lithotripsy in urolithiasis. An update]
1Urologisk avdeling Kirurgisk klinikk Aker sykehus, Oslo.
Summary
Second-generation lithotriptors offer nearly painless extracorporeal shock wave treatment for urolithiasis but may require repeat treatments due to reduced stone fragmentation effectiveness. Treatment outcomes depend on various stone and patient factors.
Area of Science:
- Urology
- Nephrology
- Medical Technology
Background:
- Extracorporeal shock wave lithotripsy (ESWL) is a primary treatment for urolithiasis.
- Advancements in lithotriptor technology aim to improve patient comfort and treatment efficacy.
Purpose of the Study:
- To review the current role and effectiveness of extracorporeal shock wave treatment for urolithiasis.
- To analyze factors influencing treatment outcomes and discuss bioeffects.
Main Methods:
- Review of personal experience and recent scientific literature on extracorporeal shock wave lithotripsy.
- Analysis of indications, contraindications, and treatment outcomes based on stone characteristics and patient anatomy.
Main Results:
- Second-generation lithotriptors provide less painful treatment but may be less effective in fragmenting stones, potentially increasing retreatment rates.
- Optimal treatment candidates include kidney stones <2.5 cm or ureteral stones with normal urinary tract anatomy.
- Stone burden, location, composition, infection, and intrarenal anatomy significantly impact outcomes; residual fragments can be clinically relevant.
Conclusions:
- Extracorporeal shock wave lithotripsy remains a viable option for upper urinary tract stones, with outcomes influenced by multiple factors.
- While generally safe with transient bioeffects, the link between ESWL and new-onset hypertension requires further investigation.
- Management of complex cases may necessitate combination therapy.