The success of SWL depends on the efficacy of the lithotripter and the following factors:
- size, location (ureteral, pelvic or calyceal), and composition (hardness) of the stones (Section 3.4.9.3);
- patient’s habitus (Section 3.4.10.3);
- performance of SWL (best practice, see below).
Each of these factors significantly influences the retreatment rate and final outcome of SWL.
Summary of evidence and guidelines for SWL
| Summary of evidence | LE |
| Stepwise power ramping prevents renal injury. | 1b |
| Clinical experience has shown that repeat sessions are feasible (within one day for ureteral stones). | 4 |
| Optimal shock wave frequency is 1.0 to 1.5 Hz. | 1a |
| Proper acoustic coupling between the cushion of the treatment head and the patient’s skin is important. | 2 |
| Careful imaging control of localisation of stone contributes to outcome of treatment. | 2a |
| Careful control of pain during treatment is necessary to limit pain-induced movements and excessive respiratory excursions. | 1a |
| Antibiotic prophylaxis is recommended in the case of internal stent placement, infected stones or bacteriuria. | 1a |
| Recommendations | Strength rating |
| Ensure correct use of the coupling agent because this is crucial for effective shock wave transportation. | Strong |
| Maintain careful fluoroscopic and/or ultrasonographic monitoring during shock wave lithotripsy (SWL). | Strong |
| Use proper analgesia because it improves treatment results by limiting pain-induced movements and excessive respiratory excursions. | Strong |
| Prescribe antibiotics prior to SWL in the case of infected stones or bacteriuria. | Strong |
Treatment algorithm for renal stones (if/when active treatment is indicated)
