Medical Shockwave was introduced long before it was used to treat stone disease. First Use of Shockwave Not many people know of..........

A patent application for the first shock wave generator to be used for the treatment of brain tumours was filed in the United States by F. Rieber as long ago as 1947. (click here to read more)

It started with soft tissue therapy and all the I need to say that today majority of the development and applications are in field of Shockwave Therapy.

USG guided SWL

Ultrasound guided SWL for lower ureteric calculus. 35 years old patient presented with dysuria. On investigation was diagnosed to have 24 mm right lower ureteric calculus.
Patient was treated with USG guided SWL. patient was given total of 3500 shockwaves under USG guidance.
Post SWL patient passed all the calculus fragments in 48 hours.

Treatment of kidney stone

All kidney stone below 20 mm can be treated with lithotripsy provided anatomy is favorable.

Investigation required prior to lithotripsy
1) Intravenous pyelography or CT Urography.
2) Urine culture and sensitivity.
3) Coagulation profile.

Results depends on type of lithotripay machine hence system should meeting following points.

1) Electromagnetic lithotripsy system.
2) Large focal zone (focal zone is area where energy ia delived)
-"IT IS MYTH THAT LARGE FOCAL CAUSES RENAL DAMAGE, IN FACT NARROW FOCAL ZONE MACHINE CAUSES MORE RENAL DAMAGE"
3) Dynamic viewing that is Ultrasound as imaging modality.
4) Energy ramping where sufficient number of energy level stepa are available to fragment stone.

If above this are fullfilled you stone is will definitely be cleared.

"IT IS NOT ONLY DOCTOR BUT SYSTEM COMTRIBUTES TO 75% When lithotripsy is advised. "

Inside Kidney Stone Disease

Treating Upper pole calculus with lithotripsy

If you come across a stone in Upper pole with rib overlying the stone. How will you treat such stones with lithotripsy? what to direct shockwave without damaging rib?
9 out of 10 Urologist would fail in such cases.
Some special skills are required how to do that. watch out.

Approach to treat ureteic calculus.

Direction of shockwave entry is most important as far as results and injury to the organ is concerned.

According to me the best direction to treat the Urinary stone disease is retroperitoneal (Posterior) approach for renal and upper ureteic calculus.

As illustrated in the diagram if we have anterior or transperitoneal (Anteriror) approach for ureteric calculus changes of intestinal injury is high. Ureter being retroperitoneal organ, its advisable that shockwave axis is retroperitoneal and not laterally or anteriorly.

Second energy and frequecy for ureteric stone is high, which can lead to more damage to abdominal organ in anterior approach of shockwave.

"ALWAYS USE POSTERIOR APPROACH IF YOU ARE TREATING URETERIC CALCULUS."

Lithotripsy for pancreatic calculus

It is surprising that when it comes to gastrointestinal calculus lithotripsy there is no emphasis on technology and physics its all about blindly following what some people are doing. Need to educate gastrointestinal surgeons regarding physics of Lithotripsy so that they are better position to adapted new technology and other systems

Master of Lithotripsy (ESWL) and ESWT http://mastersoflithotripsy.blogspot.com/