Yuen Steffi Kar Kei, Gauhar Vineet, Chai Chu Ann, Forbes Connor M, Wong Victor K F, Paterson Ryan F, Ko Ivan Ching Ho, Li Joseph, Castellani Daniele, Chew Ben H
S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
European Association of Urology Section of Endourology (ESEUT), Arnhem, The Netherlands.
World J Urol. 2025 Apr 25;43(1):250. doi: 10.1007/s00345-025-05645-x.
Urolithiasis, a condition affecting approximately 10% of the global population, is primarily treated with Shock Wave Lithotripsy (SWL) and endoscopic methods. However, SWL's high-pressure pulses can cause tissue injury, often necessitates some level of anaesthesia, and may require repeated sessions or ancillary treatment to achieve stone free status. Burst Wave Lithotripsy (BWL) emerges as a promising alternative, utilizing multi-cycle, ultrasound bursts at lower pressure amplitude to fragment stones, while minimizing cavitation under real-time imaging in a portable manner.
This scoping review evaluated BWL's efficacy, safety, and clinical potential. A systematic search identified 19 eligible studies, including in vitro experiments, preclinical trials, and human clinical trials.
In vitro studies demonstrated BWL's capability to fragment urinary stones of diverse compositions with high comminution rates. Higher ultrasound frequencies produced smaller fragments (< 1 mm), while lower frequencies resulted in larger fragments (3-4 mm), allowing for controlled fragmentation tailored to clinical needs. Preclinical trials in porcine models showed lower pressure and reduced cavitation, which account for BWL's safety, causing less associated tissue injury even in anticoagulated subjects. Human trials reported BWL as well tolerated in awake patients with high fragmentation success rates (88-91%) and low complication rates. BWL offers distinct advantages, including lower cavitation and tissue injury risks, portability, and anaesthesia-free application. Ongoing trials aim to validate BWL's efficacy and explore its combined use with ultrasonic propulsion.
BWL represents a paradigm shift in lithotripsy, offering controlled fragmentation, reduced tissue injury, fragment propulsion and portability for office-based or ambulatory care. Early clinical evidence underscores its safety and efficacy, even in anticoagulated patients. While large-scale trials are needed to solidify its role, BWL's procedural flexibility positions it as a transformative alternative to SWL, poised to redefine urolithiasis management.
尿石症影响着全球约10%的人口，主要通过冲击波碎石术（SWL）和内镜方法进行治疗。然而，SWL的高压脉冲会导致组织损伤，通常需要一定程度的麻醉，并且可能需要多次治疗或辅助治疗才能实现结石清除。爆波碎石术（BWL）作为一种有前景的替代方法出现，它利用多周期、低压力振幅的超声脉冲来破碎结石，同时在实时成像下以便携式方式将空化作用降至最低。
本综述评估了BWL的疗效、安全性和临床潜力。系统检索确定了19项符合条件的研究，包括体外实验、临床前试验和人体临床试验。
体外研究表明，BWL能够以高粉碎率破碎各种成分的尿路结石。较高的超声频率产生较小的碎片（<1毫米），而较低的频率产生较大的碎片（3 - 4毫米），从而能够根据临床需求进行可控的碎石。猪模型的临床前试验显示压力较低且空化作用减少，这说明了BWL的安全性，即使在抗凝患者中也能减少相关组织损伤。人体试验报告称，清醒患者对BWL耐受性良好，碎石成功率高（88 - 91%），并发症发生率低。BWL具有明显的优势，包括较低的空化和组织损伤风险、便携性以及无需麻醉即可应用。正在进行的试验旨在验证BWL的疗效，并探索其与超声推进联合使用的情况。
BWL代表了碎石术的范式转变，为门诊或流动护理提供了可控的碎石、减少的组织损伤、碎片推进和便携性。早期临床证据强调了其安全性和有效性，即使在抗凝患者中也是如此。虽然需要大规模试验来巩固其作用，但BWL的操作灵活性使其成为SWL的变革性替代方法，有望重新定义尿石症的治疗。
