Department of Urology, SLK Kliniken Heilbronn.
Department of Urology, Medical School Mannheim, University of Heidelberg, Heidelberg, Germany.
Curr Opin Urol. 2020 Mar;30(2):120-129. doi: 10.1097/MOU.0000000000000732.
The aim of the article is to evaluate the actual role of extracorporeal shock-wave lithotripsy (ESWL) in the management of urolithiasis based on the new developments of flexible ureterorenoscopy (FURS) and percutaneous nephrolithotomy (PCNL).
In Western Europe, there is a significant change of techniques used for treatment of renal stones with an increase of FURS and a decrease of ESWL. The reasons for this include the change of indications, technical improvement of the endourologic armamentarium, including robotic assistance. Mostly relevant is the introduction of digital reusable and single-use flexible ureterorenoscopes, whereas micro-PCNL has been abandoned. Some companies have stopped production of lithotripters and novel ideas to improve the efficacy of shock waves have not been implemented in the actual systems. Promising shock-wave technologies include the use of burst-shock-wave lithotripsy (SWL) or high-frequent ESWL. The main advantage would be the very fast pulverization of the stone as shown in in-vitro models.
The role of ESWL in the management of urolithiasis is decreasing, whereas FURS is constantly progressing. Quality and safety of intracorporeal shock-wave lithotripsy using holmium:YAG-laser under endoscopic control clearly outweighs the advantages of noninvasive ESWL. To regain ground, new technologies like burst-SWL or high-frequent ESWL have to be implemented in new systems.
本文旨在基于软式输尿管镜（FURS）和经皮肾镜碎石术（PCNL）的新进展，评估体外冲击波碎石术（ESWL）在治疗尿路结石中的实际作用。
在西欧，治疗肾结石的技术有显著变化，FURS 的应用增加，ESWL 的应用减少。原因包括适应证的改变、包括机器人辅助在内的腔内器械技术的改进。最相关的是数字化可重复使用和一次性使用的软式输尿管镜的引入，而微经皮肾镜碎石术已被放弃。一些公司已停止生产碎石机，而提高冲击波疗效的新想法尚未在实际系统中实施。有前途的冲击波技术包括使用爆发式冲击波碎石术（SWL）或高频 ESWL。其主要优势在于如在体外模型中所展示的，非常快速地粉碎结石。
ESWL 在尿路结石治疗中的作用正在减弱，而 FURS 则在不断发展。在腔镜控制下使用钬：YAG 激光进行腔内冲击波碎石术的质量和安全性显然优于无创性 ESWL 的优势。为了重新获得优势，必须在新系统中实施新的技术，如爆发式 SWL 或高频 ESWL。
