Is Extracorporeal Shock Wave Lithotripsy (ESWL) the same as lithotripsy?

Lithotripsy and ESWL: Understanding the Terminology

Extracorporeal Shock Wave Lithotripsy (ESWL) is a specific type of lithotripsy, not synonymous with lithotripsy as a whole. 1, 2 Lithotripsy is the broader term that encompasses various techniques for breaking up stones, while ESWL refers specifically to the non-invasive method that uses shock waves delivered from outside the body.

Types of Lithotripsy Procedures

• Extracorporeal Shock Wave Lithotripsy (ESWL): A non-invasive technique that uses shock waves generated outside the body to fragment urinary tract stones under fluoroscopic and/or ultrasound guidance 2

• Intracorporeal Lithotripsy: Procedures where stone fragmentation occurs inside the body, including:

  • Ureteroscopic lithotripsy: Using semi-rigid or flexible ureteroscopes with various energy sources 3, 4
  • Laser lithotripsy: Typically using holmium laser delivered through endoscopes 5
  • Pneumatic lithotripsy: Using pneumatic energy delivered through endoscopes 4
  • Electrohydraulic lithotripsy: Using electrical pulses to create shock waves directly at the stone 1

• Pancreatoscopy-directed lithotripsy: A specialized form of intracorporeal lithotripsy used for pancreatic duct stones 1

Clinical Applications and Differences

• ESWL applications:

  • Commonly used for kidney stones ≤15mm 2
  • Effective for small (≤10mm) distal ureteric stones 3
  • Used for pancreatic duct stones >5mm 1

• Procedural differences:

  • ESWL is performed externally without endoscopic access 2
  • Other lithotripsy methods require direct visualization through endoscopes 3, 4, 5

• Efficacy comparison:

  • ESWL typically has higher retreatment rates (40-45%) compared to ureteroscopic lithotripsy (8-18%) 3, 4
  • Stone-free rates are generally higher with ureteroscopic approaches (80-94%) compared to ESWL (50-92%), depending on stone location and size 3, 5, 6

Clinical Decision Making

• Stone size considerations:

  • For stones ≤10mm in distal ureter: ESWL may be preferred due to lower complication rates 3
  • For stones >10mm or proximal ureteric stones: Ureteroscopic approaches often show better outcomes 3, 4

• Patient-specific factors:

  • ESWL is generally less invasive but may require multiple sessions 3, 6
  • Ureteroscopic approaches typically require anesthesia but may achieve faster stone clearance 5, 6

Common Pitfalls and Caveats

• Terminology confusion: The terms are often incorrectly used interchangeably in clinical settings 1, 2

• Treatment selection: Stone characteristics (size, location, density) should guide the choice between ESWL and other lithotripsy methods 2, 6

• Availability limitations: ESWL for certain applications (e.g., pancreatic stones) is not widely available in all regions, necessitating alternative lithotripsy approaches 1

• Pediatric considerations: Both ESWL and flexible ureteroscopy (FURS) are viable options for pediatric renal stones, with FURS showing higher stone-free rates but longer hospital stays and operative times 1