Rigi10™ Malleable Penile Prosthesis
Also Known As
Extracorporeal Shock Wave Lithotripsy (ESWL), Shock Wave Lithotripsy (SWL), Laser Lithotripsy, Holmium Laser Lithotripsy, Ultrasonic Lithotripsy, Pneumatic Lithotripsy, Electrohydraulic Lithotripsy (EHL), Stone Fragmentation Therapy, Burst Wave Lithotripsy (BWL)
Definition
Lithotripsy is a non-invasive or minimally invasive medical procedure used to break up stones in the urinary tract, including the kidneys, ureters, bladder, and urethra, into smaller fragments that can be passed naturally through urination.1 The term “lithotripsy” derives from Greek words “litho” (stone) and “tripsy” (crushing).2 There are several types of lithotripsy, with the most common being Extracorporeal Shock Wave Lithotripsy (ESWL), which uses high-energy shock waves generated outside the body and focused on the stone.3 Other methods include Laser Lithotripsy, which utilizes laser energy delivered through a flexible scope inserted into the urinary tract to fragment stones.4 Lithotripsy revolutionized kidney stone treatment in the early 1980s by providing an alternative to invasive surgical procedures, significantly reducing recovery time and complications.5
Clinical Context
Lithotripsy is primarily indicated for the treatment of urinary tract stones that are too large to pass naturally (typically >5mm) or those causing significant pain, obstruction, or infection.1 Patient selection criteria include stone size, composition, and location, with optimal results typically seen in stones less than 2cm in diameter.2 Extracorporeal Shock Wave Lithotripsy (ESWL) is generally recommended for uncomplicated kidney stones located in the renal pelvis or upper/middle calyx, while stones in the lower pole may have lower clearance rates.3
Factors affecting treatment success include stone density (measured in Hounsfield units on CT scan), skin-to-stone distance, and patient body habitus.4 Patients with a BMI >30 or skin-to-stone distance >10cm may have reduced efficacy with ESWL due to shock wave attenuation through tissue.5 Certain stone compositions, such as cystine, brushite, or calcium oxalate monohydrate, are more resistant to shock wave fragmentation and may require alternative approaches.6
The procedure is typically performed on an outpatient basis under sedation or light anesthesia. For ESWL, patients lie on a water-filled cushion or in a water bath while approximately 1,000-2,000 shock waves are delivered over 45-60 minutes.7 Recovery is generally rapid, with most patients able to resume normal activities within 1-2 days, though they may experience hematuria and mild discomfort as fragments pass.8 Success rates vary by stone characteristics but range from 50-90% for appropriately selected patients.9