Extracorporeal shock wave therapy and percutaneous nephrolithotripsy

Nephrolithiasis is a common disease. It is estimated that the lifetime risk of urinary tract stone formation is 5-15 % and appears to be increasing in the United States. The disease afflicts men in excess of women in a 1.3:1 proportion (J Urol 173:848, 2005; Kidney Int 69:760-764, 2006). About 12 % of American population will develop renal stones by the age of 70 years. Patients with nephrolithiasis relapse at a rate of 50 % within 5-10 years and 75 % within 20 years (Lancet 367:333-344, 2006). Although the majority of patients with nephrolithiasis are managed conservatively, surgical interventions remain the mainstay for more complicated renal calculi. Traditional open surgical treatments essentially disappeared by the 1990s, after less invasive surgical approaches were introduced and refined. Two techniques, percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL), and their anesthetic implications are discussed.