الفهرس 
? Shock Wave GenerationOnly 14 pages are availabe for public view
 |  | from | 161 |  |  |
| | | from | 161 | | |
Abstract
ESWL has revolutionized the treatment of stone disease and remains the first option for most renal and ureteral stones. However, better understanding of the physics of shock wave delivery is required, together with treatment optimization, which limits renal damage and offers better selection of patients. The improved outcome of SWL will offer the maximum benefit to patients and physicians, as well as provide better value for money for health care providers. However, the original unmodified HM3 is classified as the model of superior engineering and reliability. Decrease the frequency of shock wave delivery lead to increase per shock efficiency. A higher delivery rate may interfere with subsequent shock waves, thus lowering the efficiency of treatment. Treatment with SWL has a low morbidity and high effectiveness, the number and location of stones and a history of urolithiasis significantly influence recurrence. The SFRs were higher in children than in adults older than 20 years and the older the patient the lower the SFR. ESWL is the standard procedure for renal stones of maximum diameter ≤ 20 mm or a surface area of ≤ 300 mm2 and remains the primary treatment for most uncomplicated upper urinary tract calculi even with the refinement of endourologic methods for stone removal such as URS and PNL. Repeated ESWL sessions with a stent can be a reasonable treatment for patients with small staghorn stones and a non dilated system. BMI and HUs were statistically significant independent predictors of SFRs after ESWL. With a statistically significant correlation between HU and ESWL success; Lower stone mean HU levels predicted higher rates of success and increased number of ESWL sessions needed for complete fragmentation by increased HU. Patients with calculi >750 HU were 10.5 times more likely to need ≥3 SWL sessions compared with those with calculi of ≤750 HU. Brushite (calcium phosphate), calcium oxalate monohydrate, and cystine stones are particularly resistant to SWL. Newer generation lithotripters are less painful and the use of local anesthetic cream in pain with ESWL reportedly reduces opioid requirement by 23%, thus reducing their side effects. ESWL does not affect GFR over the long term and SWs energy induces transient functional damage of tubular function in children. And the renal vasoconstriction induced by ESWL is greater in small kidneys than in large ones. Although pregnancy is the only absolute contraindication to ESWL; there are case reports of successful delivery of healthy babies with no detectable malformations or chromosomal anomalies despite the inadvertent applications of ESWL during pregnancy.