Methods

A literature search was performed with the Medline database on ESWL between 1980 and 2004.

Results

ESWL application has been intuitively connected to complications. These are related mostly to residual stone fragments, infections, and effects on tissues such as urinary, gastrointestinal, cardiovascular, genital, and reproductive systems. Recognition of ESWL limitations, use of alternative therapies, correction of pre-existing renal or systemic disease, treatment of urinary tract infection, use of prophylactic antibiotics, and improvement of ESWL efficacy are the most important measures of prevention. Decrease of shock wave number, rate and energy, use of two shock-wave tubes simultaneously, and delivery of two shock waves at carefully timed close intervals improve ESWL efficacy and safety.

Conclusion

ESWL is a safe method to treat stones when proper indications are followed. The need for well-designed prospective randomised trials on aetiology and prevention of its complications arises through the literature review.

Andreas Skolarikos^a, Gerasimos Alivizatos^a, Jean de la Rosette<sup>b

a</sup> Urology Department, Athens Medical School, Sismanoglio Hospital, Athens, Greece
^b Urology Department, Amsterdam Medical Centre, University Hospital Amsterdam, The Netherlands

Accepted 30 January 2006 published online 6 February 2006.