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PRESENTATIONIndications, prediction of success and methodsto improve outcome of shock wave lithotripsyof renal and upper ureteral calculi.Andreas Skolarikos, Heraklis Mitsogiannis, Charalambos Deliveliotis2 nd Department of Urology, Athens Medical School, Sismanoglio Hospital, GreeceSummaryObjectives: To clarify the current indications, factors influencing outcome and methodsto predict and improve the results of shock wave lithotripsy for the treatment ofrenal and upper ureteral calculi.Material and methods: English literature on the Medline and MeSH databases wasreviewed. Key words used for search included shock wave lithotripsy, calculi, stones,renal, kidney, ureter, efficacy, prediction, improvement and guidelines.Results: Shock wave lithotripsy still has certain indications for renal and upper ureteral stones.Major impact on outcome has the stone size, with a diameter of less than 20 mm being the cutoffpoint. Shock wave monotherapy should not be used for larger stones and should be combinedwith other treatment modalities such as percutaneous nephrolithotomy or ureteroscopy. Otherfactors influencing outcome include stone number, composition and location, existence of congenitalabnormalities, obesity and bleeding diathesis. Nomograms, artificial neural networksand computed tomography are useful adjuncts in predicting the outcome. Potential methods ofimprovement are the decrease of shock wave rate, the progressive increase in lithotripter output,the use of two simultaneous or sequential pulses and the use of expulsive and chemolytictreatment.Conclusions: Shock wave lithotripsy continues to be a significant part in the urologists armamentariumfor the treatment of renal and upper ureteral stones.KEY WORDS: Urinary calculi; Flexible ureteroscopy; Children.Submitted 9 May 2009; Accepted 30 June 2009INTRODUCTIONIn 1982 the introduction of extracorporeal shock wavelithrotripsy (SWL) revolutionized the treatment of urinarycalculi (1). Soon it was realized that not all stonesare amenable to adequate fragmentation and spontaneouspassage. Moreover, SWL’s complication profile wasproved to be minor but countable. As a consequence,after the initial major technological breakthrough, therehave been numerous changes in the theoretical backgroundand the technique of SWL, as well as technologicaladvances in the Lithotripters that have attempted toimprove its efficacy and decrease the interrelated morbidity.Parallel to SWL revolution, other minimally invasivetechniques, such as percutaneous lithotripsy (PNL),retrograde intrarenal surgery and laparoscopy haveemerged and also have been improved through the years.The latter techniques proved to be highly successful andof low morbidity, further decreasing the therapeuticspectrum of SWL. As a consequence, currently, urologistshave to choose among various approaches to treatrenal and upper ureteral calculi and should individualizetherapy of every patient.MATERIAL AND METHODSEnglish literature on the Medline and MeSH databaseswas reviewed. Key words used for search included shockwave lithotripsy, calculi, stones, renal, kidney, ureter, efficacy,prediction, improvement and guidelines. The aimwas to review the functional results of SWL, to examinethe factors which affect its success and to present currentguidelines on SWL treatment of renal stones and proximalureteral stones. Methods to predict which patientswould benefit from SWL and methods to improve SWLefficacy were also reviewed.56Archivio Italiano di Urologia e Andrologia 2010; 82, 1