Come funziona la ESWL di quarta generazione?

Ultimo aggiornamento: Agosto 15, 2026

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Extracorporeal Shockwave Lithotripsy (ESWL) is a minimally invasive treatment for kidney stones. This article explains what the 4th generation of lithotripter technology added over earlier machines. It is written as general education about the technology itself — it does not describe the equipment at any one hospital. For Istruzioni post-ESWL per il paziente e il storia di tutte le 4 generazioni di ESWL, vedi gli articoli collegati.

A note on our own equipment: ESWL at Bangkok Hospital Headquarters is currently performed with a third-generation lithotripter, as a daycare procedure with short-acting intravenous analgesia or light sedation for comfort. I introduced 4th-generation ESWL to Cambodia at Royal Phnom Penh Hospital in 2018, after training at Chang Gung Memorial Hospital in Taiwan — but that machine is not the one in use at BHQ today.

• Centro di urologia Ospedale di Bangkok Thailandia Prenotazione online 02-310-3009 bhquro@bdms.co.th
• Ospedale Samitivej Sriracha Chonburi 088-022-1445

Come ESWL lavoro?

• La tecnologia ESWL è sorta come una scoperta casuale durante la Seconda Guerra Mondiale ed è stata perfezionata attraverso 4 generazioni. Ogni generazione offre un migliore controllo del dolore e meno complicazioni.
• La testa dell'onda d'urto viene posizionata sul fianco del paziente (l'area dove si trova il rene). La macchina genera impulsi a onde d'urto che viaggiano attraverso la pelle e scompongono i calcoli renali in piccoli frammenti.
• Una volta frammentato, il normale flusso continuo di urina dal rene espelle i frammenti di calcolo attraverso la normale minzione.

What 4th Generation ESWL added over previous generations

• Sistema di tracciamento automatico — 4th-generation machines use an automated targeting system that continuously tracks and locks onto the stone. This helps shockwaves hit the stone accurately and reduces unnecessary energy delivery to surrounding kidney tissue
• Less need for sedation — because less energy reaches tissue around the stone, the procedure is generally better tolerated, and many centres perform it as a daycare treatment with minimal or no sedation
• Higher reported targeting accuracy — manufacturer and comparative reports describe a hit rate of around 98.5% for 4th-generation systems, against roughly 82.6% for 3rd-generation machines
• Meno complicazioni — greater targeting precision means less trauma to surrounding renal tissue

None of this means older machines do not work. A 3rd-generation lithotripter remains an effective, well-established treatment for appropriately selected stones; the practical difference is that patients are given short-acting intravenous analgesia or light sedation for comfort during the session.

ESWL success rates by stone size

The European Association of Urology (EAU) 2020 guidelines recommend ESWL for kidney stones under 2 cm. Success is defined as stone fragments < 4 mm on follow-up imaging. Reported outcomes fall broadly in these ranges:

• Pietra < 1 cm: around 84% success
• Calcolo 1-2 cm: around 77% success
• Pietra > 2 cm: around 60% success

Stone size is only one factor. Stone density on CT, its position within the kidney, the patient’s body habitus, and the distance from skin to stone all influence how well any lithotripter performs.

Domande frequenti sulla litotrissia extracorporea a onde d'urto di quarta generazione

What makes 4th Generation ESWL different from previous generations?

The defining feature of 4th-generation ESWL is its auto-tracking system, which continuously locks onto the kidney stone as it moves with breathing. Reported targeting accuracy is around 98.5%, compared with roughly 82.6% for 3rd-generation machines. Better targeting means less energy reaches the tissue around the stone, which reduces discomfort during the session and allows many centres to treat with minimal or no sedation. Earlier-generation machines remain effective; they simply rely more on operator adjustment and on giving the patient analgesia or light sedation for comfort.

Le dimensioni dei calcoli renali che possono essere trattati con l'ESWL variano, ma generalmente si ritiene che sia più efficace per calcoli fino a 2 cm.

The European Association of Urology (EAU) guidelines recommend ESWL for kidney stones under 2 cm. Reported success rates are approximately 84% for stones under 1 cm, 77% for 1–2 cm stones, and 60% for stones over 2 cm, where success is defined as residual fragments under 4 mm at follow-up. Stones larger than 2 cm may require additional sessions or an alternative procedure. Guidelines list percutaneous nephrolithotomy (PCNL) as first-line above 2 cm, but PCNL requires a tract created through the flank into the kidney; Dr. Soarawee’s preference is to attempt retrograde intrarenal surgery (RIRS) with the holmium laser wherever it is feasible, since it reaches the stone through the natural urinary passage with no incision and modern flexible ureteroscopy handles stones of almost any size. Stone density, position and body habitus also affect the result.

Is ESWL painful, and is anesthesia required?

This depends on the generation of machine. General anesthesia is not required for ESWL in either case. With a 4th-generation system, the auto-tracking function limits shockwave energy reaching tissue around the stone, so many centres treat with minimal or no sedation. With a 3rd-generation lithotripter — which is what is used at Bangkok Hospital Headquarters — patients are given short-acting intravenous analgesia or light sedation so the session is comfortable. Either way ESWL is a daycare procedure: patients go home the same day, with no post-anesthetic recovery stay.

Se Le sono stati diagnosticati calcoli renali e desidera discutere della litotrissia extracorporea a onde d'urto (ESWL) o di altre opzioni di trattamento per i calcoli renali, la Dottoressa Soarawee Weerasopone offre consulti specialistici presso la sede centrale dell'ospedale di Bangkok. Prenota una consulenza. È possibile fissare un appuntamento presso l'Ospedale Samitivej Sriracha chiamando il reparto di urologia al numero 088-022-1445.

Disclaimer: Questo contenuto è stato scritto e revisionato dal Dr. Soarawee Weerasopone, urologo certificato presso la sede centrale del Bangkok Hospital. È destinato unicamente a scopi educativi e non costituisce un parere medico. Nessun parere medico, diagnosi o prescrizione viene fornito tramite canali di messaggistica personale. Consultare sempre un professionista sanitario qualificato prima di iniziare qualsiasi trattamento medico.