Physics of Shock-wave Lithotripsy
This chapter provides a state-of-the-art and comprehensive review of the physics of shock-wave lithotriosy (SWL). Following a brief introduction about the primary technologies used in shock-wave generation, focusing, coupling, and stone localization, we first describe succinctly the acoustics of lithotripter shock-wave–stone interaction with emphasis on energy partition at the fluid/stone interface. We thereafter clarify the mechanisms of stone fragmentation in different phases of SWL and demonstrate the progression in stone comminution using a heuristic model that incorporates two important lithotripter field parameters (pressure and dose) that critically influence the treatment outcome. Moreover, we summarize current knowledge about tissue injury. Finally, we highlight recent development in SWL technology, and provide a guideline for better lithotripter design and rational selection of clinical treatment strategy with an outlook of future research directions.
