Contemporary clinical practice of shock wave lithotripsy: a reevaluation of contraindications.

PURPOSE: The current clinical practice of shock wave lithotripsy is reviewed, specifically regarding patients in whom the presence of presumed absolute or relative contraindications may preclude treatment.

MATERIALS AND METHODS: Peer reviewed basic scientific and clinical studies on shock wave lithotripsy in patients with urinary stones and concomitant conditions that might contraindicate treatment reported between 1982 and 1996 were critically reviewed.

RESULTS: The exclusion of patients with conditions previously believed to contraindicate shock wave lithotripsy has almost always been empiric rather than based on experimental or clinical studies showing adverse effects in those settings. The contemporary literature suggests that shock wave lithotripsy in patients with proximate calcified aneurysms, implanted cardiac pacemakers and defibrillators, and bleeding diatheses can be accomplished safely and effectively with careful treatment and monitoring before, during and after shock wave lithotripsy. Likewise, patients with morbid obesity, children, and those with mid and distal ureteral calculi can also be treated successfully, even with first generation lithotriptors, with minor modifications that allow for appropriate positioning of the patient and stone.

CONCLUSIONS: The designation of most conditions as absolute or relative contraindications to shock wave lithotripsy has been empiric. A review of experimental and clinical studies pertinent to these issues clearly shows that most concomitant conditions previously precluding shock wave treatment can be circumvented to allow safe and effective use of this minimally invasive technology. Currently, pregnancy is the only condition that should remain an absolute contraindication to this treatment.