What is the efficacy of extracorporeal shockwave lithotripsy (ESWL) for the treatment of nephrolithiasis?

Updated: Jun 21, 2018
  • Author: Chirag N Dave, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

A systematic review found that the majority of studies showed no evidence that ESWL causes long-term adverse effects, including arterial hypertension, diabetes mellitus, kidney dysfunction, or infertility. [75] Nevertheless, a shift seems to be occurring from the use of ESWL to that of ureteroscopy, due to the latter’s greater efficacy. [76] A meta-analysis comparing the two approaches showed that although ESWL was just as effective for the management of stones less than 1 cm in the proximal ureter, ureteroscopy otherwise had the following advantages{ref77):

  • Higher stone-free rates (92% versus 77%
  • Less frequent need for retreatment (3% versus 21%)
  • Greater efficacy in obese patients

Although data has been somewhat conflicting, it is recommended by the EAU and urologic community that MET be used as an adjunct to ESWL to expedite stone passage, increase SFRs and potentially reduce analgesic requirements. [1]


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