Extracorporeal shock wave lithotripsy. Noninvasive treatment for urinary stones.

As with many new treatments in medicine, time will determine the place of extracorporeal shock wave lithotripsy (ESWL) in management of urinary calculi. It may be that a combination of methods will prove most effective. However, at the present time, ESWL provides a noninvasive means of fragmenting calculi so that stones that were previously manageable only by invasive techniques potentially can be passed from the urinary tract. ESWL is a 30- to 45-minute treatment that yields a 50% to 75% stone-free rate at three months after the procedure. Of course, interpretation of success rates can vary on the basis of patient selection and the size, position, and composition of the stone. At this point, ureteroscopy and cystoscopic stone basketing remain the treatments of choice for low ureteral stones. Nonetheless, ESWL is an exciting new weapon in our battle against stone disease.