SWL is a reliable and efficient outpatient treatment option for urinary calculi less than 2 cm in diameter. Currently, pregnancy is the only absolute contraindication to SWL. New generation lithotriptors require only intravenous sedation-analgesia. The use of EMLA cream (eutectic mixture of lidocaine and prilocaine), a topical agent, has been shown to reduce anesthetic requirements and to shorten the recovery time after SWL.
Patients with renal anomalies have a lower stone-free rate. In horseshoe kidneys prone positioning may be necessary to localize a stone. However, in this group, stone free rates are at best 50% due to poor passage of fragments. Lower pole calyceal stones of one cm or larger may fragment well but are not likely to pass. A new strategy of combining retrograde flexible endoscopy with SWL has helped to successfully localize and treat stones associated with intrarenal stenoses and concomitant renal and ureteral stones.
The effects of SWL on renal hemodynamics have been extensively reviewed in animal models and in the human kidney. Functional and enzymatic studies before and after treatment demonstrate most SWL induced effects are transient. The production of oxygen free radicals, heat shock proteins or other inflammatory processes has been identified.
Complications of SWL include macroscopic hematuria in all patients. Renal or perirenal hematomas occur in a small percentage of patients. Post-SWL morbidity most commonly relates to the passage of stone fragments.
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