The success of SWL depends on the efficacy of the lithotripter and the following factors:

  • size, location (ureteral, pelvic or calyceal), and composition (hardness) of the stones (Section;
  • patient’s habitus (Section;
  • performance of SWL (best practice, see below).

Each of these factors significantly influences the retreatment rate and final outcome of SWL.

Summary of evidence and guidelines for SWL

Summary of evidenceLE
Stepwise power ramping prevents renal injury.1b
Clinical experience has shown that repeat sessions are feasible (within one day for ureteral stones).4
Optimal shock wave frequency is 1.0 to 1.5 Hz.1a
Proper acoustic coupling between the cushion of the treatment head and the patient’s skin is important.2
Careful imaging control of localisation of stone contributes to outcome of treatment.2a
Careful control of pain during treatment is necessary to limit pain-induced movements and excessive respiratory excursions.1a
Antibiotic prophylaxis is recommended in the case of internal stent placement, infected stones or bacteriuria.1a
RecommendationsStrength rating
Ensure correct use of the coupling agent because this is crucial for effective shock wave transportation.Strong
Maintain careful fluoroscopic and/or ultrasonographic monitoring during shock wave lithotripsy (SWL).Strong
Use proper analgesia because it improves treatment results by limiting pain-induced movements and excessive respiratory excursions.Strong
Prescribe antibiotics prior to SWL in the case of infected stones or bacteriuria.Strong

Treatment algorithm for renal stones (if/when active treatment is indicated)