SWL for large urinary stones | Clinical insights into non-invasive treatment

Clinical Insights: Shockwave Lithotripsy (SWL) for Large Urinary Stones — Effectiveness & Outcomes. SWL for large urinary stones: Clinical insights into non-invasive treatment?. The clinical experience with over 2,000 Extracorporeal Shock Wave Lithotripsy (SWL) procedures shows that modern shock wave technology like the MODULITH® SLX-F2 »FD21« can reliably fragment even dense or unusually shaped stones measuring 1 cm or more – often in a single session. A structured protocol including preventive ureteral stenting demonstrates good clinical results without the need for invasive intervention. In this expert article, Dr Nika Gagoshidze and Professor Guram Karazanashvili from the Karazanashvili Robotic Center in Tbilisi share their clinical insights and explain why SWL remains a reliable first-line therapy even for complex urinary stones. Clinical results with SWL for large urinary stones. How effective is Extracorporeal Shock Wave Lithotripsy for treating urinary stones 1 cm and larger – and can it reliably reduce the need for repeat sessions? In our clinical practice, we aimed to answer this using a structured treatment protocol and modern SWL technology. Across 2,000 procedures, we found that even large, dense, or unusually shaped stones could be successfully treated in a single session – without the need for anaesthesia, and with minimal complications. Our data and clinical experience highlight SWL as a safe, non-invasive first-line option for managing complex urinary stones. One session is often enough – regardless of stone size or density. We treated a broad range of stones using the MODULITH SLX-F2 »FD21« lithotripter, including:. 780 kidney stones measuring 1–2 cm, 326 kidney stones between 2–5 cm, 10 kidney stones over 5 cm, 135 ureteral stones measuring 1–2 cm, Notably, medical guidelines of the European Association of Urology recommend performing percutaneous nephrolithotomy (PNL) as first option and SWL as second option for stones between 2 and 5 cm in size. According to the standard, patients with stones between 2 and 5 cm were offered PNL as first option and SWL as second option. For stones larger than 5 cm surgical treatment was categorically offered to patients. We generally opted for SWL for patients with high risks of surgical complications or resistant infection. From these cases, 1,238 stones had a density above 1,000 Hounsfield units yet fragmented efficiently. Overall, 76.2% of patients were stone-free at one month, with an additional 20.6% at three months, and 1.7% at six months. Only 84 patients (4.2%) required a repeat procedure. Patients were classified as stone-free when no residual calculi were identified on flat-panel X-ray images. Stone-free rates were assessed at one, two- and three-months following treatment.