Improving shockwave lithotripsy outcomes

Shockwave lithotripsy (SWL) is one of the most consistently utilized procedures for the treatment of upper urinary tract stones. SWL was initially applied widely as a treatment for upper tract stones until the limitations of the technology became apparent. Over the last decade a number of advances have been introduced that have improved SWL outcomes without the use of new or improved lithotripters and these measures have contributed to maintaining the widespread applicability of SWL in the treatment of urinary stones. These advances include refining patient selection, including the use of nomograms, to increase the chance of successful treatment. Medication adjuncts have been used as part of SWL treatment to enhance stone fragmentation and potentially reduce SWL-induced renal injury. Pharmacologic and mechanical measures have been initiated to improve stone clearance and reduce post-SWL recurrences. This chapter will review these nontechnologic advances that have been introduced to enhance SWL outcomes.