AUA white paper on SWL: Benefits usually outweigh risks

The potential benefits of shock wave lithotripsy (SWL) outweigh the foreseeable risks of this treatment, according to a recently released white paper from AUA.

AUA developed the white paper to provide expert opinion on the safety of SWL, the significance of chronic adverse events, and whether the benefits of SWL outweigh the risks.

In the paper, experts also advocate new measures to reduce the risk of renal injury from SWL. Institution of new pretreatment protocols is recommended, including providing a brief, 3- to 4-minute pause in shock wave delivery soon after the initiation of treatment. Research using animal models has shown that instituting such a pause is protective and reduces bleeding within renal tissue.

The white paper also calls for practitioners to slow the shock wave firing rate to reduce renal injuries and improve stone breakage outcomes. While the typical firing rate is 120 SW per minute, new research shows that slowing the shock wave rate to 60 SW per minute could reduce the risk of renal injury. Although the slower SW rate may require a modest increase in overall treatment time, clinical studies show improved success rates at the slower rate, and experts say a longer treatment time is preferable to risking renal injury.

"The field of SWL is continually advancing," said Dean G. Assimos, MD, a member of the panel that developed the paper. "It is important for all practitioners to be aware of these new treatment protocols so that they can reduce the risk of renal injury for patients suffering from stones."