title: Extracorporeal shockwave lithotripsy for upper tract urolithiasis.
abstract: OBJECTIVE
  For the last three decades, extracorporeal shockwave lithotripsy (SWL) has been the mainstay of management of urolithiasis; recognized widely by patients and physicians for its noninvasive approach and good outcomes. Recent challenges by endoscopic approaches have driven ongoing research to refine indications, define outcomes and explore innovations.
  
  
  RESULTS
  Utilization of SWL remains high, despite increasing utilization of endoscopic approaches. Patient selection is critical--outcomes with percutaneous nephrolithotomy and ureteroscopy after failed SWL are not as good as those obtained in patients who have not had prior SWL. A structured training in ultrasound localization and proper patient positioning can have dramatic impacts on stone-free results. Stone size, location, Hounsfield unit stone attenuation and stone volume remain important predictors of outcomes. Renal cysts may negatively impact outcomes with SWL.
  
  
  CONCLUSIONS
  These recent studies highlight important considerations for patient selection, SWL technique and follow-up for patients undergoing SWL. New technologies hold promise but require further study.
authors.affiliation: Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Weaver
authors.forename: Manoj
authors.initials: M
authors.lastname: Monga
mesh_terms: D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects; D018579:Patient Selection; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome; D052878:Urolithiasis / Q000175:diagnosis / Q000628:therapy*