How to choose lithotripsy unit ?

1. What is the focal zone of the lithotripter?
2. What is the peak pressure at the focal zone?
3. Is the energy delivery at focal zone consistent?
4. Is the energy delivered at focal zone adequate (not more than required for stone fragmentation)?
5. Do I have enough control over the energy delivered manually?
6. Do I have enough steps of increasing energy before I reach desired energy level?
7. Does every patient require anesthesia for lithotripsy?
8. Do I have dynamic monitoring of stone during lithotripsy?

Try to grade lithotripsy unit in following category.

Properties of lithotripsy		Machine A	Machine B	Machine C
Focal zone	Larger the better
Energy delivery at focal zone
Is the energy at focal zone constant
Control over the energy delivered manually	Does machine have manual selection of energy
Steps of increasing energy before you reach desired energy level	More the steps better
Patient require anesthesia (GA/SA)	Ideally no anesthesia or only analgesia should be required
Dynamic monitoring -USG	USG is better for Lithotripsy
Total score

Heel pain and ESWT

15 % of adults compain of heel pain
1 out of 8 patient visiting orthopedicean has heel pain
1/4 of all foot injury and 8% of overall injuries to runner and other athletes is heel pain


Only option available is Local steroid

But with now ESWT the results are amazing

Today ESWT is standard treatment for Plantar fasciatis

ESWT for Diabetic foot ulcer

Background: Diabetes is becoming one of the most common chronic diseases, and ulcers are its most serious complication. Beginning with neuropathy, the subsequent foot wounds frequently lead to lower extremity amputation, even in the absence of critical limb ischemia. In recent years, some researchers have studied external shock wave therapy (ESWT) as a new approach to soft tissue wound healing. The rationale of this study was to evaluate if ESWT is effective in the management of neuropathic diabetic foot ulcers.

Methods: We designed a randomized, prospective, controlled study in which we recruited 30 patients affected by neuropathic diabetic foot ulcers and then divided them into two groups based on different management strategies. One group was treated with standard care and shock wave therapy. The other group was treated with only standard care. The healing of the ulcers was evaluated over 20 weeks by the rate of re-epithelization.

Results: After 20 weeks of treatment, 53.33% of the ESWT-treated patients had complete wound closure compared with 33.33% of the control patients, and the healing times were 60.8 and 82.2 days, respectively (p < 0.001). Significant differences in the index of the re-epithelization were observed between the two groups, with values of 2.97 mm2/die in the ESWT-group and 1.30 mm2/die in the control group (p < 0.001).

Conclusion: Therefore, ESWT may be a useful adjunct in the management of diabetic foot ulceration.

Latest development in eswl

Have recently done a case of AML kidney with the renal stone have treated it with ESWL.
Isocentric sonography was used to localise the stone.

Soon telling you all the technique by my publication.

Pls let me know if there is any feedback on same

Thanks and regards