title: The effect of rate of shock wave delivery on the efficiency of lithotripsy.
abstract: OBJECTIVE
  The potential mechanisms of a shock wave rate effect are reviewed here, together with a report on the results of in-vitro, in-vivo and clinical studies that have assessed the effect of altering the shock wave rate on stone breakage and tissue injury by shock wave lithotripsy.
  
  
  RESULTS
  The vast majority of studies assessing shock wave rate have reported improved stone fragmentation and a reduction in shock wave lithotripsy-induced tissue damage with slower rates of shock wave delivery. However, the optimal shock wave rate has not been determined.
  
  
  CONCLUSIONS
  Slower rates of shock wave lithotripsy appear to improve the efficiency of this approach and therefore this suggests the need for a randomized clinical trial to assess shock wave rate.
authors.affiliation: Methodist Hospital Institute for Kidney Stone Disease, Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Ryan F
authors.initials: RF
authors.lastname: Paterson
authors.forename: Ramsay L
authors.initials: RL
authors.lastname: Kuo
authors.forename: James E
authors.initials: JE
authors.lastname: Lingeman
mesh_terms: D000818:Animals; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*; D008096:Lithotripsy / Q000379:methods*; D023421:Models, Animal; D016896:Treatment Outcome