Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. May 6, 2015; 4(2): 230-234
Published online May 6, 2015. doi: 10.5527/wjn.v4.i2.230
Strategies to optimize shock wave lithotripsy outcome: Patient selection and treatment parameters
Michelle Jo Semins, Brian R Matlaga
Michelle Jo Semins, University of Pittsurgh Medical Center, Pittsburgh, PA 15213, United States
Brian R Matlaga, Johns Hopkins Medical Institutions, Baltimore, MD 21287, United States
Author contributions: Semins MJ and Matlaga BR equally contributed to this work.
Conflict-of-interest: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Brian R Matlaga, MD, MPH, Johns Hopkins Medical Institutions, Park 200, 600 N Wolfe Street, Baltimore, MD 21287, United States.
Telephone: +1-410-5027710 Fax: +1-410-5017711
Received: August 5, 2014
Peer-review started: August 6, 2014
First decision: October 31, 2014
Revised: December 11, 2014
Accepted: December 18, 2014
Article in press: December 20, 2014
Published online: May 6, 2015

Shock wave lithotripsy (SWL) was introduced in 1980, modernizing the treatment of upper urinary tract stones, and quickly became the most commonly utilized technique to treat kidney stones. Over the past 5-10 years, however, use of SWL has been declining because it is not as reliably effective as more modern technology. SWL success rates vary considerably and there is abundant literature predicting outcome based on patient- and stone-specific parameters. Herein we discuss the ways to optimize SWL outcomes by reviewing proper patient selection utilizing stone characteristics and patient features. Stone size, number, location, density, composition, and patient body habitus and renal anatomy are all discussed. We also review the technical parameters during SWL that can be controlled to improve results further, including type of anesthesia, coupling, shock wave rate, focal zones, pressures, and active monitoring. Following these basic principles and selection criteria will help maximize success rate.

Keywords: Shock wave lithotripsy, Kidney stones, Nephrolithiasis, Treatment outcome, Optimization

Core tip: Shock wave lithotripsy is a commonly utilized technology for kidney stone treatment that has declining efficacy over the past decade. The paper outlines how to optimize outcomes with proper patient selection and control of treatment parameters.