Extracorporeal Shock Wave Lithotripsy: Sonographic and Medical Imaging and Procedure Review

George Tsoukatos, BPS, R.T. (R)(ARRT)®*

^*Medical Imaging Consultant, Germantown, NY

Address correspondence to: George Tsoukatos, BPS, R.T. (R)(ARRT)^®*, Radiology Support Services, PO Box 215, Germantown, NY 12526. E-mail: radiologytechnique@gmail.com.

Disclosure Statement: The author reports having no significant financial or advisory relationships with corporate organizations related to this activity.

ABSTRACT

The formation of kidney stones, known as nephrolithiasis, is a common, painful condition that often requires surgery in patients whose stones do not pass on their own. Urolithiasis occurs when these stones are located in, or migrate to, any part of the urinary tract, including the kidneys, ureters, bladder, and urethra, which is also a common urological disease with an increasing prevalence. Prior to the introduction of extracorporeal shockwave lithotripsy (ESWL) in 1980, the only treatment available for patients with stones that could not pass through the urinary tract was invasive surgery. Since then, ESWL has become a preferred tool in urologists' armamentarium for treating patients with proximal and midureteral stones. Compared with open and endoscopic procedures, ESWL is minimally invasive, requires less anesthesia, and yields equivalent stone-free rates in appropriately selected patients. Different stone sizes, composition, location, and various patient factors all contribute to determining if a patient is a candidate for ESWL. ESWL utilizes many preprocedural imaging modalities, including diagnostic sonography, digital radiography, CT, and fluoroscopy, for renal stone evaluation and localization, as well as for stone fragment monitoring, and assessing the effectiveness of ESWL. All aspects of patient evaluation before and after ESWL procedures, as well as performing EWSL itself, are important and detailed processes that radiologic technologists who care for and image patients with these conditions should be well versed in, all of which will be covered in this course.

Author's Note: For the context of this course, the terms nephrolithiasis, renal calculi, and kidney stones will be used interchangeably based on how they are referred to in the originally referenced sources.