ABSTRACT

Shock-wave lithotripsy (SWL) was first performed by Chaussy and colleagues in Munich in 1980 utilizing a prototype device that was created by Dornier, a West German aerospace firm, as a spin-off of military research.(1) The first widely distributed clinical lithotriptor, the Dornier HM3, was introduced in 1983 and continues to be in use today, 25 years after its introduction. (2) The first SWL treatment in the United States was performed by Dr. James E. Lingeman at Methodist Hospital in Indianapolis in February, 1984.(3) The initial results for treatment of renal calculi with SWL were very encouraging and thus resulted in the rapid acceptance of this noninvasive technology as a treatment alternative for renal and ureteral calculi.(3)

Following its introduction into clinical use, SWL was applied to a broad spectrum of upper urinary tract stone problems. With growing experience, urologists realized that there was a limit to the ability of the kidney and ureter to discharge stone fragments and, thus, the concept of stone burden (stone size and number) became important in selecting appropriate patients for SWL. Other factors such as stone composition and variations in renal anatomy have also become appreciated as important factors influencing SWL outcomes. Unfortunately, the assessment of the merits of SWL relative to other minimally invasive treatment modalities such as ureteroscopy and percutaneous stone removal have been hindered by the lack of high-quality data. The vast majority of data published on SWL outcomes arise from single institution case series. There is very little level 1 evidence available to help guide decision making for most clinical and stone parameters. Furthermore, decisions about SWL indications are distorted by a common treatment philosophy around the world which is since SWL in noninvasive multiple treatments can be applied without damage to the patient.