title: Recent advances in lithotripsy technology and treatment strategies: A systematic review update.
abstract: BACKGROUND
  Shock wave lithotripsy (SWL) is a well - established treatment option for urolithiasis. The technology of SWL has undergone significant changes in an attempt to better optimize the results while reducing failure rates. There are some important limitations that restrict the use of SWL. In this review, we aim to place these advantages and limitations in perspective, assess the current role of SWL, and discuss recent advances in lithotripsy technology and treatment strategies.
  
  
  METHODS
  A comprehensive review was conducted to identify studies reporting outcomes on ESWL. We searched for literature (PubMed, Embase, Medline) that focused on the physics of shock waves, theories of stone disintegration, and studies on optimising shock wave application. Relevant articles in English published since 1980 were selected for inclusion.
  
  
  RESULTS
  Efficacy has been shown to vary between lithotripters. To maximize stone fragmentation and reduce failure rates, many factors can be optimized. Factors to consider in proper patient selection include skin - to - stone distance and stone size. Careful attention to the rate of shock wave administration, proper coupling of the treatment head to the patient have important influences on the success of lithotripsy.
  
  
  CONCLUSIONS
  Proper selection of patients who are expected to respond well to SWL, as well as attention to the technical aspects of the procedure are the keys to SWL success. Studies aiming to determine the mechanisms of shock wave action in stone breakage have begun to suggest new treatment strategies to improve success rates and safety.
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: H E
authors.initials: HE
authors.lastname: Elmansy
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA. Electronic address: jlingeman@IUHealth.org.
authors.forename: J E
authors.initials: JE
authors.lastname: Lingeman
mesh_terms: D006801:Humans; D008096:Lithotripsy / Q000379:methods / Q000592:standards*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D052878:Urolithiasis / Q000628:therapy*
keywords: Lithotripsy; Lithotripter; Shock wave generation; Urolithiasis