Use of lithotripsy for treatment of nephroliths and ureteroliths

摘要

Extracorporeal shock-wave lithotripsy (ESWL) refers to stone fragmentation by shock-waves that are generated outside the body. ESWL uses repeated shock-waves to cause implosion of the nephrolith into many small fragments that can pass spontaneously through the excretory system. In humans ESWL is the treatment of choice for 80 to 90% of patients with nephrolithiasis. Initially, ESWL was not believed to cause renal damage; subsequent studies in humans, dogs, and minipigs have shown that ESWL causes intrarenal hemorrhage. The severity of damage induced by shock-waves is dependent on the dose (voltage and number of shock-waves) and frequency (number of shock-waves per second). Despite the ESWL-induced morphologic damage, studies of renal function in dogs and minipigs have shown minimal decreases in glomerular filtration rate (GFR) and renal blood flow (RBF) 24-hours after ESWL; GFR and RBF returned to pre-treatment values within 1 week.