The Effect Of Shock Wave Rate On The Outcome Of Shock Wave Lithotripsy: A Meta-Analysis

UroToday.com- In this manuscript, the authors reviewed 4 randomized trials of shock wave lithotripsy comparing slow shock wave delivery (i.e. 60 shock waves/ min) to rapid shock wave delivery (120 shocks/minute), comprising 589 patients treated on 4 different lithotriptors (2 with electrohydraulic and 2 with electromagnetic energy sources). The bottom line is that slower is better (p = 0.002). The data support this approach regardless of stone size, despite one trial in which the benefits were more apparent among stones > 1 cm. The mechanism of action for the beneficial effect of the slower treatment delivery may relate to irregularities along the stone's surface that may blunt the negative pressure portion of the shock wave at the higher delivery level. I think this paper makes it very clear; regardless of your type of lithotriptor, the results will likely be better if you treat at 60 shock waves/ minute.