title: Extracorporeal shock wave lithotripsy in the treatment of renal and ureteral stones.
abstract: The use of certain technical principles and the selection of favorable cases can optimize the results of extracorporeal shock wave lithotripsy (ESWL). The aim of this study is to review how ESWL works, its indications and contraindications, predictive factors for success, and its complications. A search was conducted on the Pubmed® database between January 1984 and October 2013 using "shock wave lithotripsy" and "stone" as key-words. Only articles with a high level of evidence, in English, and conducted in humans, such as clinical trials or review/meta-analysis, were included. To optimize the search for the ESWL results, several technical factors including type of lithotripsy device, energy and frequency of pulses, coupling of the patient to the lithotriptor, location of the calculus, and type of anesthesia should be taken into consideration. Other factors related to the patient, stone size and density, skin to stone distance, anatomy of the excretory path, and kidney anomalies are also important. Antibiotic prophylaxis is not necessary, and routine double J stent placement before the procedure is not routinely recommended. Alpha-blockers, particularly tamsulosin, are useful for stones >10mm. Minor complications may occur following ESWL, which generally respond well to clinical interventions. The relationship between ESWL and hypertension/diabetes is not well established.
authors.affiliation: Hospital das Clínicas, Medical School's, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Fábio César Miranda
authors.initials: FC
authors.lastname: Torricelli
authors.affiliation: Hospital das Clínicas, Medical School's, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Danilovic
authors.affiliation: Hospital das Clínicas, Medical School's, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Fábio Carvalho
authors.initials: FC
authors.lastname: Vicentini
authors.affiliation: Hospital das Clínicas, Medical School's, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Giovanni Scala
authors.initials: GS
authors.lastname: Marchini
authors.affiliation: HC, FM, USP, Brazil.
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
authors.affiliation: HC, FM, USP, Brazil.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Mazzucchi
mesh_terms: D002986:Clinical Trials as Topic; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000628:therapy*