Petrides Neophytos, Ismail Safiyah, Anjum Faqar, Sriprasad Seshadri
Department of Urology, Darent Valley Hospital, Dartford, UK.
Turk J Urol. 2020 Nov;46(Supp. 1):S19-S26. doi: 10.5152/tud.2020.20441. Epub 2020 Oct 30.
Since its introduction in the early 1980s, extracorporeal shockwave lithotripsy (ESWL) has proven to be a minimally invasive and efficient procedure for the management of renal calculi. It is currently one of the most recommended treatments for small- and medium-sized stones (<20 mm) in most guidelines internationally. The recent coronavirus disease 2019 (COVID-19) outbreak could lead to a further increase in ESWL use as it avoids a general anesthetic and its potential complications in patients with COVID-19 infection. Most publications exhibit ESWL stone-free rates (SFRs) of 70%-80%; however, this is often not the case in many centers, with multiple factors affecting the efficacy of the intervention. Various stone and patient factors have been shown to influence the ESWL success. Stone position, density and size, skin-to-stone distance, and body-mass index contribute to SFRs. Modifications in the lithotripter design and revisions in the technique have also improved the SFRs over the years, with slower shock rates, power-ramping protocols, combined real-time ultrasound, and fluoroscopy imaging technology, all enhancing the efficacy. The adjuvant use of pharmacological agents, such as alpha-blockers, potassium citrate, and the emerging microbubble technology, has also been investigated and shown promising results. Arguably, the most significant determinant of the success of ESWL in a particular unit is how the lithotripsy service is set up and monitored. Careful patient selection, dedicated personnel, and post-treatment imaging review are essential for the optimization of ESWL. Through an analysis of the published studies, this review aimed to explore the measures that contribute to an effectual lithotripsy service in depth.
自20世纪80年代初问世以来，体外冲击波碎石术（ESWL）已被证明是一种治疗肾结石的微创且高效的方法。在目前国际上大多数指南中，它是治疗中小尺寸结石（<20 mm）最推荐的方法之一。近期的2019冠状病毒病（COVID-19）疫情可能导致ESWL的使用进一步增加，因为它避免了全身麻醉及其在COVID-19感染患者中可能出现的并发症。大多数出版物显示ESWL的结石清除率（SFRs）为70%-80%；然而，在许多中心情况往往并非如此，有多种因素影响该干预措施的疗效。各种结石和患者因素已被证明会影响ESWL的成功率。结石位置、密度和大小、皮肤到结石的距离以及体重指数都会影响结石清除率。多年来，碎石机设计的改进和技术的修订也提高了结石清除率，较慢的冲击速率、功率递增方案、实时超声联合荧光透视成像技术都提高了疗效。还对α受体阻滞剂、柠檬酸钾等药物制剂的辅助使用以及新兴的微泡技术进行了研究，并显示出有前景的结果。可以说，在特定单位中ESWL成功的最重要决定因素是碎石服务的设置和监测方式。仔细的患者选择、专业人员以及治疗后影像学检查对于优化ESWL至关重要。通过对已发表研究的分析，本综述旨在深入探讨有助于实现有效碎石服务的措施。
