title: Extracorporeal shock wave lithotripsy: What is new?
abstract: OBJECTIVE
  Thirty years after its introduction, extracorporeal shockwave lithotripsy (ESWL) is still first-line treatment for more than half of all urinary tract stones, but machines and treatment strategies have significantly developed over time. In this review, we summarise the latest knowledge about the clinically important aspects of ESWL.
  
  
  METHODS
  We searched PubMed to identify relevant reports and the latest European Association of Urology guidelines, and standard urological textbooks were consulted.
  
  
  RESULTS
  New technical developments include: Twin-head and tandem-pulse shock-wave generators; wide-focus, low-pressure systems; optimised coupling; and automated location and acoustic tracking systems. Indications have been refined, making possible the identification of patients in whom ESWL treatment is likely to fail. By lowering the shock-wave rate, improving coupling, applying abdominal compression, power 'ramping' and postoperative medical expulsion therapy, treatment protocols have been optimised.
  
  
  CONCLUSIONS
  Promising new technical developments are under development, with the potential to increase the stone-free rate after ESWL. For optimal results, the refined indications need to be respected and optimised treatment protocols should be applied.
authors.affiliation: Endourology and Stone Services, Barts and The London NHS Trust, United Kingdom.
authors.forename: Christian
authors.initials: C
authors.lastname: Bach
authors.affiliation: Endourology and Stone Services, Barts and The London NHS Trust, United Kingdom.
authors.forename: Theocharis
authors.initials: T
authors.lastname: Karaolides
authors.affiliation: Endourology and Stone Services, Barts and The London NHS Trust, United Kingdom.
authors.forename: Noor
authors.initials: N
authors.lastname: Buchholz
keywords: EAU, European Association of Urology; ESWL; Lithotripter; Optimisation; PCNL, percutaneous nephrolithotomy; Shockwave lithotripsy; Technique; US, ultrasonography