Renal adverse effects of extracorporeal shock wave lithotripsy

Extracorporeal shockwave lithotripsy is not a novel therapeutic method in the treatment of urolithiasis. It uses shock waves (SW) created in the generator outside of the body that are then focused and directed on the calculus in the patient's body. It is the method of choice for the treatment of kidney stones smaller than 20 mm, and those in the proximal part of the ureter (up to 10 mm). Complications are relatively rare and most often clinically insignificant. SW can reversibly -damage all parts of the renal parenchyma. The degree of damage depends on the number of SW and the energy level delivered to a particular tissue. Such changes are most often asymptomatic. Microhaematuria is present in virtually all patients, and macrohaematuria occurs in about 1/3 of patients. A rare but serious complication is a kidney rupture that requires surgical care that can sometimes lead to a nephrectomy. The occurrence of perinephric or subcapsular hematoma is rare and usually requires only conservative therapy. Despite the aforementioned negative impact of SW on the renal parenchyma (primarily around the calculus), studies have not shown that treatment with this method leads to significant renal function impairment in either the adult or paediatric population.