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Objectives Thirty years after its introduction, extracorporeal shockwave lithotripsy (ESWL) is still first-line treatment for more than half of all urinary tract stones, but machines and treatment strategies have significantly developed over time. In this review, we summarise the latest knowledge about the clinically important aspects of ESWL. Methods We searched PubMed to identify relevant reports and the latest European Association of Urology guidelines, and standard urological textbooks were consulted. Results New technical developments include: Twin-head and tandem-pulse shock-wave generators; wide-focus, low-pressure systems; optimised coupling; and automated location and acoustic tracking systems. Indications have been refined, making possible the identification of patients in whom ESWL treatment is likely to fail. By lowering the shock-wave rate, improving coupling, applying abdominal compression, power ‘ramping’ and postoperative medical expulsion therapy, treatment protocols have been optimised. Conclusions Promising new technical developments are under development, with the potential to increase the stone-free rate after ESWL. For optimal results, the refined indications need to be respected and optimised treatment protocols should be applied.

To report our preliminary series with the Doli S EMSE 220F-XXP, the upgraded version of the previous Dornier Lithotripter S EMSE 220, for treatment of ureteral stones. Since July 2006, a total of 200 patients with ureteral stones were submitted to shock wave lithotripsy (SWL) with Doli S EMSE 220F-XXP. Mean stone size was 9.3 mm (range 6–18 mm). Ureteral stone location was proximal in 75, middle in 34, and distal in 91. Follow-up was carried out at 6 weeks after the treatment, by means of kidney–ureter–bladder (KUB) film and ultrasound, or helical computed tomography (CT). The overall stone-free rate was 89.5%, and the effectiveness quotient was 80. Stratifying by stone site, the stone-free rate was 93.3, 67.6, and 94.5% for proximal, middle, and distal location, respectively. Mean number of sessions per patient was 1.14. Analgesia with intravenous ketorolac or tramadol was required in 42.5% of cases. No significant side-effects were recorded. The new Doli S EMSE 220F-XXP provides similar characteristics to the Doli S EMSE 220 in terms of safety and lack of major complications, when dealing with ureteral stones; the improvement in stone disintegration is particularly evident for distal location, for which the number of pulses and the intensity of treatment can be greatly increased and the upgraded power of the device can be widely applied.

Objetivo: La litiasis de la vía urinaria es una patología de gran prevalencia para cuyo tratamiento se han utilizado diversos dispositivos a lo largo de la historia. El StoneBreakerTM (LMA Urology, Gland, Switzerland) pertenece a una segunda generación de litotriptores intracorpóreos, neumático y portátil, que aporta algunas ventajas respecto a otros dispositivos, tanto por su eficacia en la fragmentación de las litiasis como por su fácil manejo, muy útiles durante la realización de la nefrolitotomía percutánea. Métodos/Resultados: Presentamos el caso de un varón de 40 años con litiasis piélica de riñón izquierdo, al que se realiza nefrolitotomía percutánea bajo anestesia general, usando como litotriptor para la fragmentación de la misma el StoneBreakerTM (LMA Urology, Gland, Switzerland). Conclusión: El StoneBreakerTM (LMA Urology, Gland, Switzerland) es un litotriptor para uso con endoscopios rígidos o semirrígidos, con mayor poder de fragmentación que sus antecesores, que consigue disminuir el número de disparos necesarios para la fragmentación de las litiasis, sin que esto repercuta en un aumento del daño tisular. Además también ha sido diseñado con una mayor comodidad de uso, gracias a que no precisa de conexiones y se acciona por medio de cartuchos desmontables de dióxido de carbono. Objective: Throughout the history, many devices have been used for breaking urinary tract stones. StoneBreakerTM (LMA Urology, Gland, Switzerland) is a second generation of intracorporeal lithotripter, pneumatic and portable, which adds several new advantages, like effectiveness in stone fragmentation and easy handling, very useful during percutaneous lithotripsy. Methods/Results: We report the case of a 40 year-old male patient, with a left kidney pyelic lithiasis, who was treated by percutaneous lithotripsy, under general anaesthesia, with StoneBreakerTM (LMA Urology, Gland, Switzerland) as lithotripter. Conclusions: StoneBreakerTM (LMA Urology, Gland, Switzerland) is a lithotripter usable with rigid and semirigid ureteroscopes, much more powerful than its predecessors. It is able to decrease the number of shocks necessary for stone fragmentation, without bigger tissue reaction. It also has a more comfortable design due to the absence of connections, and its power by replaceable carbon dioxide cartridges.

International audience; Purpose: Delivering a drug close to the targeted cells improves its benefit versus risk ratio. A possible method for local drug delivery is to encapsulate the drug into solid microscopic carriers and to release it by ultrasound. The objective of this work was to use shock waves for delivering a molecule loaded in polymeric microcapsules. Material and methods: Ethyl benzoate (EBZ) was encapsulated in spherical gelatin shells by complex coacervation. A piezocomposite shock wave generator (120 mm in diameter, focused at 97 mm, pulse length 1.4 ls) was used for sonicating the capsules and delivering the molecule. Shock parameters (acoustic pressure, number of shocks and shock repetition frequency) were varied in order to measure their influence on EBZ release. A cavitation-inhibitor liquid (Ablasonic Ò) was then used to evaluate the role of cavitation in the capsule disruption. Results: The measurements showed that the mean quantity of released EBZ was proportional to the acoustic pressure of the shock wave (r 2 > 0.99), and increased with the number of applied shocks. Up to 88% of encapsulated EBZ could be released within 4 min only (240 shocks, 1 Hz). However, the quantity of released EBZ dropped at high shock rates (above 2 Hz). Ultrasound imaging sequences showed that cavitation clouds might form, at high shock rates, along the acoustic axis making the exposure inefficient. Measurements done in Ablasonic Ò showed that cavitation plays a major role in microcapsules disruption. Conclusions: In this study, we designed polymeric capsules that can be disrupted by shock waves. This type of microcapsule is theoretically a suitable vehicle for carrying hydrophobic drugs. Following these positive results, encapsulation of drugs is considered for further medical applications.

Problem: Ermittlung des Behandlungserfolges einer Einmaltherapie der Epicondylitis humeri radialis mit der ESWT. Methode: In einem Zeitraum von 2 Jahren wurden 44 Pat. mit der elektrohydraulischen Stosswelle einmal behandelt. Die Befragung der Patienten erfolgte mittels Fragebögen, in denen Beschwerden vor und nach der Behandlung mittels visueller Analogskala erfasst wurden. Ergebnisse: Die Auswertung ergab eine Befundbesserung bei 84% der Patienten. Das subjektive Behandlungsergebnis wurde ebenfalls für 84% der Patienten ermittelt. Diskussion: Die Einmalbehandlung der Epicondylitis humeri radialis mit der elektrohydraulischen extrakorporalen Stosswelle stellt ein komplikationsarmes Verfahren und eine Alternative zur operativen Therapie dar.

Objective: The objective of this study was to evaluate the efficacy and safety of the Dornier lithotripter S II system in the treatment of ureteral calculi. Patients and Methods: A total of 97 cases which consists of 54 males and 43 females with ureteral stones were treated by extracorporeal shock wave lithotripsy (ESWL). Mean age was 42.6 years. Inclusion criteria were solitary radiopaque ureteral stones of radiological stone size of ≤1 cm. The stones were not impacted, with normal kidney functions. Procedure time, number of shocks, energy used, number of sessions and complications were reported. The outcome of ESWL was also recorded. Results: Stones were in the abdominal (upper ureter) in 50% of patients, in pelvic (middle ureter) in 47% of patients. All patients had unilateral stones and the mean stone size in maximum length was) 10 mm). Good dye excretion passing the stone was noted in all patients. Mild hydronephrosis was found in 85% of cases. A total of 49 cases were treated by a single session, while in 35% of cases two sessions were enough and 16% received three sessions. The average number of shocks per session was 3125. The average number of shocks per patient was 5962.5 shocks and average energy was 204.3 Joules. The overall stone-free rate 3 months after lithotripsy was 94%. After a single session of lithotripsy, 49 patients (49%) became stone-free. Stone free rates after ESWL for upper, middle ureteral stones were 94%, 95.7% respectively. Additional procedures were needed in only 6 cases (6%) to render patients stone-free after lithotripsy. No serious complications occurred. Conclusion: The Dornier lithotripter S II is very effective in the treatment of ureteral calculi with no major complications.