Burst wave lithotripsy: insights on effectiveness and safety.

PURPOSE OF REVIEW: Burst wave lithotripsy (BWL) has emerged as a novel noninvasive approach for urinary stone management, aiming to overcome key limitations of conventional shock wave lithotripsy, including variable efficacy, pain, and tissue injury. This review examines the growing body of experimental and early clinical evidence evaluating BWL as a noninvasive, anesthesia-sparing option for urinary stone management.

RECENT FINDINGS: Recent experimental, preclinical, and first-in-human studies demonstrate that BWL can achieve efficient stone fragmentation across a range of compositions with controllable fragment size through frequency modulation. Clinical studies report high rates of stone comminution, favorable fragment profiles, and excellent tolerability in awake patients, with predominantly low-grade adverse events. Integration with ultrasonic propulsion has further improved fragment clearance and stone-free outcomes. Preclinical data also suggest a favorable renal safety profile, including in anticoagulated models.

SUMMARY: Current evidence supports BWL as a promising complementary technology for selected patients with renal and ureteral stones, offering truly noninvasive, patient-centered care. Ongoing trials will clarify its role within treatment algorithms and define optimal indications and workflows.