Bioeffects of Extracorporeal Shock Wave Lithotripsy

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Abstract
Extracorporeal shock wave Lithotripsy (ESWL) is an effective procedure for the noninvasive treatment of renal stones. Although ESWL has been perceived to be safe, numerous recent reports have presented evidence that ESWL causes severe acute effects and may induce chronic complications. It has been demonstrated that ESWL induces tissue damage, and several urinary and serum values are elevated 24 hours after ESWL, suggesting significant trauma to the kidney and adjacent tissues. One or more forms of morphologic renal trauma occurs in 63% to 85% of all ESWL patients. These injuries range from mild contusions to large subcapsular or perinephric hematomas. More disturbing is the suggestion that ESWL may be associated with subsequent hypertension. Only a few experimental studies have been performed in animals to document the bioeffects of shock waves. The data collected from these studies indicate a high frequency of tissue damage, particularly to the kidney, similar to the structural and functional alterations observed in patients. Despite the widespread clinical use of ESWL, no systematic studies have been conducted to establish objective criteria for safe clinical use. Such studies need to be performed using both experimental models and clinical trials.