Current Role of Ultrasound in Extracorporeal Shockwave Lithotripsy

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SummaryThe broadening of the indications for extracorporeal Shockwave lithotripsy from renal to include biliary calculi has increased the role of ultrasound in this technology. Sonography remains the modality of choice in diagnosing, targeting, and performing follow-up for both stone fragment clearance and complications in the biliary tree. However, it has a more limited role in renal lithotripsy, being largely limited to follow-up studies for possible complications such as hydronephrosis or subcapsular hematomas. Piezoelectric Shockwave generation is used on a number of currently available lithotripters and has some advantages, such as truly anesthesia-free operation and relatively low operating costs, but has major limitations. The evolution in equipment design to create truly multipurpose biliary and renal lithotripters with both ultrasound and fluoroscopic targeting coupled to moderate- to high-energy-output Shockwave generating systems to maintain a high fragmentation rate with a minimum number of repeat treatments required, promises to increase the role of ultrasound in lithotripsy in the future. The role of ultrasound in biliary and renal lithotripsy in a department where both lithotripters are operated by radiologists is reviewed.

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