Current status of extracorporeal lithotripsy in China and its status Although extracorporeal lithotripsy has the reputation of being the least invasive surgical treatment, ESWL is actually a very special technique that requires doctors to have very good diagnostic skills and skills to master the instrument. Dr. Zhang Yi met with a lithotripter from the hospital of Prof. Chaussy, the inventor of the world’s first lithotripter, at the University of Munich in Germany. In the West, ESWL has strict training and certification, and the cost of treatment is extremely high, basically 2-3 treatments cost more than surgical endoscopic lithotripsy. Therefore, the German lithotripter claimed to be a trainer in lithotripsy as long as he was working on lithotripsy, and in his words “I don’t need to be a professor”. The situation in China is not as good, as lithotripsy is an excellent technique with very low pricing, ranging from 1200-1500 RMB for initial treatment and 600 RMB for resuscitation, or even less in some areas. The higher quality X-ray positioning lithotripters cost more than 1 million even domestically, and imports are 3-5 million, with space, consumables, maintenance, etc., not including the cost of doctor training and treatment here. Domestic extracorporeal lithotripters are the contribution of the older generation such as academician Wu Jieping to the motherland, producing equipment of excellent quality, which makes many large hospital doctors unmotivated to engage in ESWL due to the extremely low cost of doctors’ skills. at the same time, some manufacturers position their equipment with extremely crude ultrasound machines, producing equipment that is operated in the hands of unqualified personnel, and problems abound. In the late 1990s, Dr. Zhang Yi was fortunate enough to perform ESWL for a period of time and worked out a set of treatment procedures for his original unit that he uses today. As a result of this work, Dr. Zhang Yi joined the writing group of the Chinese Guidelines for the Treatment of Urological Diseases for extracorporeal shock wave lithotripsy, and worked with domestic experts to develop our guidelines. Through several years of work, the guidelines have been published and updated annually, but the lack of training and focus in China is still there. ESWL in the “troika” Despite all the problems, ESWL is the least invasive procedure compared to ureteroscopy and percutaneous nephrolithoscopy. It is effective in treating stones that are not too large and in the right location. However, due to the rapid development of endoscopic and laser light technology, minimally invasive surgery is becoming less invasive, and the proportion of ESWL is decreasing year by year even in foreign countries. As patients are mostly reluctant to undergo surgery, but all a treatment has its own scope of application, beyond which the efficacy decreases and the complication rate increases. Dr. Zhang Yi has seen many serious complications caused by the misuse of ESWL. Therefore, certain unfavorable factors are known and the specialist will give you a reminder, such as: 1. Large stone size: pelvic stones greater than 20mm, ureteral stones greater than 10-15mm; 2. Hard stone texture: composition of cystine stones, calcium oxalate monohydrate; 3. High CT value: greater than 900-1000, indicating high stone hardness; 4. Long stay in the ureter: greater than 2 months Stones stimulate inflammatory granulation formation in the ureteral wall; 5. Heavy hydronephrosis: poor ability to dislodge stones; 6. Poor location: if there are bones and intestines etc. blocking the middle and lower ureter; 7. Poor stone visualization and difficult localization: for X-ray localization pure uric acid stones are not visualized, poor visualization of magnesium ammonium phosphate stones. In addition to the above disadvantages, if you happen to need to receive ESWL, there are some things you should know that are also critical, including: 1. The doctor should conduct a proper assessment before lithotripsy, medical history, kidney function, blood clotting, complete imaging data, etc.; 2. The seriousness of operation and smooth communication between you and the lithotripsy; 3. The time to schedule your next review or retreatment after lithotripsy treatment, usually should not be less than 7 days; 4. 5.The number of repeat treatments should not be too many, especially in the same area; 6.Not only review the stone discharge or residual, but also pay attention to the potential complications; 7.Discuss the treatment results with you, and arrange the re-treatment or intermediate endoscopic treatment reasonably. ESWL is an excellent treatment modality for urinary stones and has an important place in the triad. However, it is also due to the small trauma, the stone clearance rate is still less than that of endoscopic surgery. Currently, ESWL status is being challenged as endoscopic stone extraction becomes more and more minimally invasive. And even with the best technology, the treatment outcome depends on well-trained surgeons, excellent equipment and suitable patients and their willingness to cooperate.