Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Apr 25;43(1):250.
doi: 10.1007/s00345-025-05645-x.

Burst wave lithotripsy - a paradigm shift: inferences from a scoping review

Steffi Kar Kei Yuen #  1   2 , Vineet Gauhar #  3   4 , Chu Ann Chai  5 , Connor M Forbes  6 , Victor K F Wong  6 , Ryan F Paterson  6 , Ivan Ching Ho Ko  7 , Joseph Li  8 , Daniele Castellani  3   9 , Ben H Chew  6
Affiliations

Burst wave lithotripsy - a paradigm shift: inferences from a scoping review

Steffi Kar Kei Yuen et al. World J Urol. .

Abstract

Purpose: Urolithiasis, a condition affecting approximately 10% of the global population, is primarily treated with Shock Wave Lithotripsy (SWL) and endoscopic methods. However, SWL's high-pressure pulses can cause tissue injury, often necessitates some level of anaesthesia, and may require repeated sessions or ancillary treatment to achieve stone free status. Burst Wave Lithotripsy (BWL) emerges as a promising alternative, utilizing multi-cycle, ultrasound bursts at lower pressure amplitude to fragment stones, while minimizing cavitation under real-time imaging in a portable manner.

Methods: This scoping review evaluated BWL's efficacy, safety, and clinical potential. A systematic search identified 19 eligible studies, including in vitro experiments, preclinical trials, and human clinical trials.

Results: In vitro studies demonstrated BWL's capability to fragment urinary stones of diverse compositions with high comminution rates. Higher ultrasound frequencies produced smaller fragments (< 1 mm), while lower frequencies resulted in larger fragments (3-4 mm), allowing for controlled fragmentation tailored to clinical needs. Preclinical trials in porcine models showed lower pressure and reduced cavitation, which account for BWL's safety, causing less associated tissue injury even in anticoagulated subjects. Human trials reported BWL as well tolerated in awake patients with high fragmentation success rates (88-91%) and low complication rates. BWL offers distinct advantages, including lower cavitation and tissue injury risks, portability, and anaesthesia-free application. Ongoing trials aim to validate BWL's efficacy and explore its combined use with ultrasonic propulsion.

Conclusion: BWL represents a paradigm shift in lithotripsy, offering controlled fragmentation, reduced tissue injury, fragment propulsion and portability for office-based or ambulatory care. Early clinical evidence underscores its safety and efficacy, even in anticoagulated patients. While large-scale trials are needed to solidify its role, BWL's procedural flexibility positions it as a transformative alternative to SWL, poised to redefine urolithiasis management.

Keywords: Break wave; Burst wave; Lithotripsy; Nephrocalcinosis; Shock wave; Ultrasound propulsion.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethical approval: Ethics approval is not required in this study. Financial disclosures: All other authors have no relevant financial or non-financial interests to disclose. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
(a) Burst Wave Lithotripsy machine; (b) Burst Wave Lithotripsy probe
See this image and copyright information in PMC

References

    1. Abufaraj M, Xu T, Cao C, Waldhoer T, Seitz C, D’Andrea D et al (2021) Prevalence and trends in kidney stone among adults in the USA: analyses of National health and nutrition examination survey 2007–2018 data. Eur Urol Focus 7(6):1468–1475. 10.1016/j.euf.2020.08.011 - DOI - PubMed
    1. Pace KT, Ghiculete D, Harju M, Honey RJ, University of Toronto Lithotripsy A (2005) Shock wave lithotripsy at 60 or 120 shocks per minute: a randomized, double-blind trial. J Urol 174(2):595–599. 10.1097/01.ju.0000165156.90011.95 - DOI - PubMed
    1. Eisenmenger W (2001) The mechanisms of stone fragmentation in ESWL. Ultrasound Med Biol 27(5):683–693. 10.1016/s0301-5629(01)00345-3 - DOI - PubMed
    1. Howard D, Sturtevant B (1997) In vitro study of the mechanical effects of shock-wave lithotripsy. Ultrasound Med Biol 23(7):1107–1122. 10.1016/s0301-5629(97)00081-1 - DOI - PubMed
    1. Pishchalnikov YA, McAteer JA, Williams JC Jr., Pishchalnikova IV, Vonderhaar RJ (2006) Why stones break better at slow shockwave rates than at fast rates: in vitro study with a research electrohydraulic lithotripter. J Endourol 20(8):537–541. 10.1089/end.2006.20.537 - DOI - PMC - PubMed

Publication types

LinkOut - more resources