4세대 ESWL은 어떻게 작동합니까?

마지막 업데이트: 8월 15, 2026

• 워드프레스
• LinkedIn
• 메일

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 체외충격파쇄석술(ESWL) 후 환자 지침 그리고 체외 충격파 쇄석술(ESWL)의 모든 4세대 역사, 관련 기사를 참조하세요.

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.

• 비뇨기과 센터 태국 방콕 병원 온라인 예약 02-310-3009 bhquro@bdms.co.th
• 사미티브 스리라차 병원 촌부리 088-022-1445

어떻게 ESWL 일?

• ESWL 기술은 제2차 세계 대전 중에 우연한 돌파구로 시작되어 4세대에 걸쳐 개량되었습니다. 각 세대는 더 나은 통증 조절과 적은 합병증을 제공합니다.
• 충격파 헤드를 신장 부위(신장이 있는 부위)에 대고 환자의 옆구리에 댑니다. 기계는 피부를 통과하여 신장 결석을 작은 조각으로 부수는 충격파 펄스를 생성합니다.
• 일단 파쇄되면, 신장에서부터 자연스럽고 연속적으로 흐르는 소변이 일반적인 배뇨를 통해 결석 조각을 배출합니다.

What 4th Generation ESWL added over previous generations

• 자동 추적 시스템 — 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
• 합병증이 더 적음 — 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:

• 돌 < 1 cm: around 84% success
• 돌 1–2cm: around 77% success
• 돌 > 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.

4세대 체외충격파쇄석술에 대한 자주 묻는 질문

4세대 체외충격파쇄석술(ESWL)은 이전 세대와 무엇이 다를까요?

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.

ESWL이 치료할 수 있는 신장 결석의 크기는 얼마인가요?

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.

체외충격파쇄석술(ESWL)은 통증이 심한가요? 마취가 필요한가요?

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.

신장 결석 진단을 받고 체외 충격파 쇄석술(ESWL)이나 다른 신장 결석 치료 옵션에 대해 논의하고 싶으시다면, Soarawee Weerasopone 박사님께서 방콕 병원 본원에서 전문 상담을 제공합니다. 진료 예약. 사미즈 시라차 병원 예약은 비뇨기과로 전화하여 하실 수 있습니다. 088-022-1445.

고지 사항: 이 콘텐츠는 방콕병원 본원의 공인 비뇨기과 전문의인 소라위 위라소폰(Soarawee Weerasopone) 박사가 작성하고 검토했습니다. 교육 목적으로만 제공되며 의학적 조언에 해당하지 않습니다. 개인 메시징 채널을 통해 의학적 조언, 진단 또는 처방은 제공되지 않습니다. 의학적 치료를 시작하기 전에 항상 자격을 갖춘 의료 전문가와 상담하십시오.