Falling Out of Favor: Practice Patterns of Shock Wave Lithotripsy in the Era of Endourology: A FUTURE Worldwide Survey
A 2026 worldwide survey reveals that shock wave lithotripsy (SWL) is utilized in a minority of stone cases and perceived as declining, with practice patterns showing significant variability in patient selection, technical delivery, and training, while AI adoption remains limited despite favorable perceptions.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Imagine kidney stones as unwanted boulders stuck in a delicate plumbing system. For decades, doctors had a "magic hammer" called Shock Wave Lithotripsy (SWL). This tool used sound waves to smash the stones into dust from outside the body, like a gentle but powerful earthquake that only the boulder could feel. It was non-invasive, didn't require cutting, and let patients go home the same day.
However, over the last 20 years, doctors have started using "plumbers' tools" (endoscopic techniques like ureteroscopy) more often because they can grab and remove stones more reliably. A new study, conducted by a global team of urologists, asked: What is happening to the "magic hammer" today? Is it still being used, how is it being used, and are doctors using new digital helpers like Artificial Intelligence (AI) with it?
Here is what the study found, explained simply:
1. The "Magic Hammer" is in the Back of the Garage
The study found that while the SWL machine is still available in many hospitals, it is rarely the first choice.
- The Stat: About 78% of the doctors surveyed said they use SWL for 15% or fewer of their stone cases. In fact, nearly 17% of them don't use it at all anymore.
- The Trend: Most doctors (about two-thirds) feel like the use of SWL is shrinking, like a tool being slowly retired from the toolbox.
- Why keep it? Even though it's used less, doctors still like it because it's non-invasive, cheap, and doesn't always require putting the patient to sleep with heavy anesthesia. It's like keeping an old, reliable screwdriver in the drawer even if you mostly use a power drill now.
2. Choosing the Right Tool is a Mix of Rules and Gut Feeling
When a doctor decides whether to use the "magic hammer" (SWL) or a "plumber's tool" (endoscopy), they mostly follow the rulebook (medical guidelines) and look at hard facts like the stone's size and density.
- The Rules: They generally avoid the hammer if the stone is too big (usually over 10mm) or too hard (like a rock with a density over 1000 HU).
- The Reality: Even with the rulebook, personal preference and what equipment is available in the hospital still play a big role. It's like a chef following a recipe but sometimes swapping an ingredient because they have a specific brand of knife or a favorite spice.
3. The Machines are Getting "Old and Tired"
The study looked at the actual machines being used.
- The Age: Most of these machines are older than 6 years, and nearly one-third are over 10 years old.
- The Variety: There is no standard way to use them. Some doctors use them fast, some slow; some use a "ramp" (gradually increasing power), others don't. It's like a group of drivers all driving the same model of old car, but everyone has their own unique way of pressing the gas and steering.
4. Who is Holding the Hammer?
Who actually performs the procedure?
- The Doctor: Usually, the main urologist does it.
- The Team: Sometimes a different doctor on the team does it.
- The Technician: Surprisingly, in about 20% of cases, a non-doctor technician performs the procedure.
- The Experience Factor: Doctors believe that who does the job matters a lot. They feel that an experienced operator gets better results. However, there is no consistent "driver's license" or formal training required to learn how to use these machines. Some centers have strict training; others have none.
5. The "Crystal Ball" (AI) is Still in the Box
Artificial Intelligence (AI) is like a crystal ball that could predict exactly how well the "magic hammer" will work or help measure the stone perfectly.
- The Reality: Despite everyone agreeing that AI could be helpful, 82% of doctors said they don't have access to it at all. Only a tiny fraction (8.5%) use it regularly.
- The Blockers: The main reasons aren't that doctors don't want it; it's that the tools aren't available, haven't been proven to work in real life yet, or are too hard to fit into their daily workflow. It's like having a blueprint for a flying car, but no one has built the engine yet.
6. How Do They Know if It Worked?
After the treatment, how do doctors know the stone is gone?
- The Messy Answer: There is no single standard. Some take an X-ray, some use ultrasound, some use a CT scan.
- Defining "Success": Most doctors consider the job done if the remaining stone fragments are tiny and won't cause pain (called "clinically insignificant"). A few are stricter and want zero dust left behind.
The Big Picture
This study is like taking a snapshot of a changing landscape. The "magic hammer" (SWL) hasn't disappeared, but it has moved from being the main event to a special option for specific situations. The way it is used varies wildly from doctor to doctor and country to country. While everyone is excited about the potential of new digital tools (AI) to make things better, those tools are mostly sitting on the shelf, waiting to be built and tested.
The authors suggest that to fix this, we need better training for the people using the machines, clearer rules on how to use them, and real-world testing to get those digital helpers into the hands of doctors.
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