ABSTRACT
The development of shock wave lithotripsy (SWL) began when engineers at Dornier, a German aerospace firm, started researching the effects of shock waves on military hardware. The report of the United States cooperative study of SWL reaffirmed the effectiveness of this therapy for the treatment of calculi in the upper urinary tract and proximal ureter with stone free rates of 77.4% at three months for patients with single stones. Although the exact mechanisms for tissue injury related to SWL remain unknown, cavitation and shear stress are thought to play a role. Lithotriptor shock waves have been shown to generate cavitation in vitro. The acute tissue effects of SWL have been well studied in animal models. The incidence of sepsis has been reported to be less than 1%; however, the rate increases to 2.7% for staghorn calculi. Renal trauma and vascular disruption induced by SWL may permit the entry of bacteria into the bloodstream.
