Litotripcia, onda de choque extracorporea (ESWL)

Shock wave lithotripsy — Extracorporeal Shock Wave Lithotripsy (ESWL)remains one of the most commonly used procedures for kidney stones worldwide [35]. SWL can be used to treat small- to medium-sized kidney stones but is not the ideal modality for the management of large or complex stones or stones located in the lower pole of the kidney. The dependent location of lower pole stones makes it more difficult for fragments produced by SWL to be cleared from the kidney. In addition, SWL should not be used in patients with obesity, who are pregnant, or with a bleeding diathesis SWL is generally performed on an outpatient basis with the patient under conscious sedation, general anesthesia, or regional anesthesia. SWL employs high-energy shock waves produced by an electrical discharge. The shock waves are transmitted through water and directly focused onto a kidney/ureteral stone with the aid of biplanar fluoroscopy. The change in tissue density between the soft kidney tissue and the hard stone causes a release of energy at the stone surface. This energy fragments the stone. The main limitations of SWL are the completeness of stone fragmentation as well as the completeness of fragment elimination. Alpha blockers (eg, tamsulosin) may be prescribed to facilitate stone passage following SWL. <a id="