Neisius A
Abteilung für Urologie und Kinderurologie, Krankenhaus der Barmherzigen Brüder Trier, Akademisches Lehrkrankenhaus der Johannes Gutenberg-Universität Mainz, Nordallee 1, 54292, Trier, Deutschland.
Urologe A. 2017 Sep;56(9):1147-1157. doi: 10.1007/s00120-017-0470-9.
Shock wave lithotripsy (SWL) became the therapy of choice for the majority of patients with urolithiasis early after its introduction in the early 1980s. Since then, SWL remains the only noninvasive therapy modality for the treatment of urinary stones. Although lithotripters became more versatile and affordable-making them available worldwide-indications for SWL have shifted as well. In most western countries, endoscopic techniques took the lead in stone therapy due to high (early) stone-free and better reimbursement rates. Notwithstanding SWL remains the first-line therapy for most intrarenal and many ureteral stones.
This contemporary review illuminates technical aspects and improvements of lithotripsy over recent years in context with the current guideline recommendations.
Technical advances in lithotripsy such as shock wave generation, focusing, coupling, stone localization and modifications in therapy regimens are reviewed and presented.
Urologists are recommended to carefully select the appropriate therapy modality for a patient with urolithiasis. A more comprehensive understanding of the physics of shock waves could lead to much better results, thus, endorsing SWL as first-line therapy for urolithiasis instead of contemporary endourology treatment options.
20世纪80年代初冲击波碎石术（SWL）问世后不久，便成为大多数尿路结石患者的首选治疗方法。从那时起，SWL仍然是治疗尿路结石的唯一非侵入性治疗方式。尽管碎石机变得更加通用且价格亲民，使其在全球范围内得以应用，但SWL的适应证也发生了变化。在大多数西方国家，由于（早期）结石清除率高且报销比例更高，内镜技术在结石治疗中占据了主导地位。尽管如此，SWL仍然是大多数肾内结石和许多输尿管结石的一线治疗方法。
本篇当代综述结合当前指南建议，阐述近年来碎石术的技术层面及改进之处。
对碎石术的技术进展进行了综述和介绍，如冲击波产生、聚焦、耦合、结石定位以及治疗方案的调整。
建议泌尿外科医生为尿路结石患者仔细选择合适的治疗方式。对冲击波物理学有更全面的了解可能会带来更好的治疗效果，因此，支持将SWL作为尿路结石的一线治疗方法，而非当代腔内泌尿外科治疗方案。
