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Abstract
<p class="first" id="d816881e55">Shock wave lithotripsy (SWL) is the process of fragmentation
of renal or ureteric
stones by the use of repetitive shock waves generated outside the body and focused
onto the stone. Following its introduction in 1980, SWL revolutionized the treatment
of kidney stones by offering patients a non-invasive procedure. It is now seen as
a mature technology and its use is perceived to be routine. It is noteworthy that,
at the time of its introduction, there was a great effort to discover the mechanism(s)
by which it works, and the type of sound field that is optimal. Although nearly three
decades of subsequent research have increased the knowledge base significantly, the
mechanisms are still controversial. Furthermore there is a growing body of evidence
that SWL results in injury to the kidney which may have long-term side effects, such
as new onset hypertension, although again there is much controversy within the field.
Currently, use of lithotripsy is waning, particularly with the advent of minimally
invasive ureteroscopic approaches. The goal here is to review the state of the art
in SWL and to present the barriers and challenges that need to be addressed for SWL
to deliver on its initial promise of a safe, effective, non-invasive treatment for
kidney stones.
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