第4世代ESWLはどのように機能しますか？

最終更新日： 8月 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 ESWL後の注意事項 そして 体外衝撃波結石破砕術（ESWL）の４世代すべての歴史, 、関連する記事をご覧ください。.

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.

• 泌尿器センター バンコク病院 タイ オンライン予約 02-310-3009 bhquro@bdms.co.th
• サミティジ・シラチャ病院 チョンブリ 088-022-1445

どのように ESWL 仕事？

• ESWL技術は第二次世界大戦中の偶発的な発見として生まれ、4世代にわたって改良されてきました。各世代で、より優れた疼痛管理と合併症の減少が実現されています。
• 衝撃波ヘッドを患者の脇腹（腎臓がある部分）に当てます。機械は皮膚を通過する衝撃波パルスを発生させ、腎結石を小さな断片に砕きます。
• 一旦砕かれた腎臓からの尿の自然で連続的な流れは、通常の排尿を通して結石の破片を洗い流します。

What 4th Generation ESWL added over previous generations

• 自動追尾システム — 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
• 合併症が少ない — 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:

• 結石 < 1 cm around 84% success
• 石 1～2 cm around 77% success
• 石 > 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.

第4世代ESWLに関するよくある質問

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.

ESWLは、直径2cm以下の腎結石、尿管結石の治療に用いられます。

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.

腎臓結石と診断され、ESWL（体外衝撃波結石破砕術）などの治療法について相談をご希望の場合は、ソアラウィ・ウィーラソポン医師がバンコク病院本社にて専門的な診察を行っております。. 診療をご予約. サミティウェート・シーラチャ病院のご予約は、泌尿器科（電話番号：）までお問い合わせください。 088-022-1445.

免責事項 この記事は、バンコク病院本部のボード認定泌尿器科医であるソアラウィー・ウィーラソポン医師（Dr. Soarawee Weerasopone）によって執筆および監修されています。教育目的のみを意図しており、医学的なアドバイスを構成するものではありません。個人的なメッセージチャンネルを通じて、医学的なアドバイス、診断、処方箋が提供されることはありません。医療処置を開始する前に、必ず資格を持った医療従事者にご相談ください。.