Extracorporeal Shock Wave Lithotripsy – a Non-Invasive Treatment Modality for Urolithiasis in University Hospital Centre Zagreb

Urolithiasis is one of the most common pathologies in urology, with high prevalence and recurrence rates.Urinary tract stones differ in their symptomatology, number, size, location, structure, as well as in some other characteristics and thus in the way of their treatment.Computed tomography (CT) is considered the best method of diagnosing stones and choosing the optimal treatment method for patients with urinary tract stones.Extracorporeal shock-wave lithotripsy (ESWL) is an effective treatment modality in patients with stones less than 20 mm in size.Because of the characteristics of stones, in some cases, more than one procedure is needed to achieve complete disintegration.From January 2019 to November 2023, 3,844 EWSL treatments for urinary tract stones were performed at the Clinical Hospital Center Zagreb Urology Clinic.The average stone size was 0.9 cm, and the average age of the patients was 53 years.One ESWL treatment was needed in 22%, two in 21%, and three in 18% of our patients.The procedure could not be performed due to the radiolucency of stones on X-ray images in 10% of patients, while it was interrupted in 3% due to pain, and in 3% of patients due to hypertension.In patients with unsuccessful extracorporeal treatments or an initially high burden of stones, some of the minimally-invasive, endoscopic methods are advised for further or initial treatment, such as ureteroscopy (URS), flexible ureterorenoscopy (FURS), percutaneous nephrolithotomy (PCNL), and endoscopic combined intrarenal surgery (ECIRS).ESWL is considered an effective, non-invasive treatment modality in selected patients, with good stone-free rates and low complication rates, which can be performed as an outpatient procedure.