Shock wave lithotripsy monotherapy for renal calculi.

Shock wave lithotripsy (ESWL) remains the most common treatment for renal calculi. In this article, recent literature pertaining to ESWL monotherapy of renal calculi was reviewed, with the goal of improving ESWL results through better case selection. When selecting the optimal surgical approach for a patient, multiple factors must be considered. Factors to consider include stone-related factors (size, number, composition and location), renal anatomical factors, and patient-related factors. Each of these factors is presented in detail, with the discussion limit to non-staghorn renal calculi. Children, the elderly, patients with hypertension, and patients with impaired renal function, may be at increased risk of ESWL complications and adverse effects and care should be taken to limit the number and energy of shock waves applied in these special cases. Absolute contraindications to ESWL remain pregnancy, distal obstruction, untreated infection, and uncorrected coagulopathy.