Indications for extracorporeal shock wave lithotripsy.
1.Kidney stones
(1) Diameter <1.0cm renal pelvic stones or stones in the upper and middle renal calyces.
(2) Diameter ≥1.0cm, but <2.0mm, and CT value HU<1000, skin-stone distance <10cm Stones in the renal pelvis or supra- and mid-renal calyces.
(3) ESWL can be preferred for inferior calyx stones <1.0cm in diameter; 1.0cm-2.0cm inferior calyx stones are determined by the presence of unfavorable factors such as: inferior calyx pelvis angle, inferior calyx neck width, inferior calyx neck length, etc.
(4) Partial deerstalker-type stones >2.0 cm but <3.0 cm in diameter, or with a surface area <500 mm 2 as an optional treatment.
(5) For other complex deerstalker-type stones, ESWL is not recommended and should be combined with PNL (percutaneous nephrolithotomy) as the last method of treatment.
2.Ureteral stones
(1) Upper segment ureteral stones <1.0cm in diameter are the best indication for ESWL, ESWL, URS (ureteroscopic lithotomy), PNL are optional for upper segment stones >1.0cm in diameter.
(2) stones <1.0cm in diameter in the middle and lower segments are elective for ESWL or URS; stones >1.0cm in diameter in the middle and lower segments are preferred for URS, and the second choice is ESWL.
(3) ESWL is less effective for stones with too long residence time or dense structure.
3.Bladder stones
ESWL can be used for adult bladder stones <3.0 cm in diameter; or if the patient refuses surgery; or if there are high risk factors for surgery; or if intraluminal lithotripsy cannot be performed in the lithotomy position.
4.Urethral stones
Posterior urethral stones should be pushed back to the bladder for further treatment.
Contraindications to extracorporeal shock wave lithotripsy.
I. Systemic conditions.
1, pregnancy.
2. uncorrected abnormalities of the coagulation mechanism.
3, severe cardiopulmonary disorders.
4, active tuberculosis of the urinary tract.
5, severe skeletal deformities or severe obesity.
II. Urinary system conditions.
1, organic obstruction distal to the stone.
2, renal insufficiency.
3, uncontrolled urinary tract infection.
III. Stone condition.
The location, size, composition, structure, morphology, duration of retention in the urinary tract, and the presence of effusion all affect the lithotripsy effect.