Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
Curr Opin Urol. 2014 Mar;24(2):168-72. doi: 10.1097/MOU.0000000000000024.
For the last three decades, extracorporeal shockwave lithotripsy (SWL) has been the mainstay of management of urolithiasis; recognized widely by patients and physicians for its noninvasive approach and good outcomes. Recent challenges by endoscopic approaches have driven ongoing research to refine indications, define outcomes and explore innovations.
Utilization of SWL remains high, despite increasing utilization of endoscopic approaches. Patient selection is critical--outcomes with percutaneous nephrolithotomy and ureteroscopy after failed SWL are not as good as those obtained in patients who have not had prior SWL. A structured training in ultrasound localization and proper patient positioning can have dramatic impacts on stone-free results. Stone size, location, Hounsfield unit stone attenuation and stone volume remain important predictors of outcomes. Renal cysts may negatively impact outcomes with SWL.
These recent studies highlight important considerations for patient selection, SWL technique and follow-up for patients undergoing SWL. New technologies hold promise but require further study.
过去三十年来，体外冲击波碎石术（SWL）一直是治疗尿路结石的主要方法；因其非侵入性的方法和良好的效果而被患者和医生广泛认可。最近，内镜治疗方法的出现带来了新的挑战，促使人们不断研究以完善适应证、定义结果并探索创新。
尽管内镜治疗方法的应用不断增加，但 SWL 的应用仍然很高。患者选择至关重要——经皮肾镜取石术和输尿管镜取石术治疗 SWL 失败后的效果不如未接受过 SWL 的患者。经过超声定位和正确患者定位的结构化培训可以对无结石结果产生显著影响。结石大小、位置、Hounsfield 单位结石衰减和结石体积仍然是影响结果的重要预测因素。肾囊肿可能会对 SWL 的结果产生负面影响。
这些最近的研究强调了对接受 SWL 治疗的患者进行患者选择、SWL 技术和随访的重要考虑因素。新技术有希望，但需要进一步研究。
