Эволюция лечения камня: от зон боевых действий до высокотехнологичного исцеления

Последнее обновление: Август 17, 2026

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Добро пожаловать в путешествие по истории и научным основам одной из самых революционных технологий в современной урологии: экстракорпоральной ударно-волновой литотрипсии (ЭУВЛ). Как сертифицированный уролог, специализирующийся на лечении почечнокаменной болезни, я хочу рассказать вам о том, как наблюдение, сделанное в военное время, превратилось в одну из самых совершенных неинвазивных процедур, доступных нам сегодня.

Эта статья основана на моей официальной презентации, представленной на Королевском семинаре по урологии в Пномпене 17 ноября 2018 года. Этот семинар остается важной вехой в моей карьере — моментом, когда мы соединили исторические корни медицинских инноваций с передовыми методами лечения, которые я сегодня применяю при работе с пациентами в головном отделении больницы «Бангкок» и в больнице «Самитиведж Срирача».

Before the History: When a Stone Becomes an Emergency

This article is about technology, and technology is the least urgent part of stone disease. Before reading on, it is worth knowing which stone situations cannot wait, because the answer to them is not a lithotripter appointment:

• Fever or shaking chills with flank pain. This suggests an infected, obstructed kidney — the true emergency of stone disease. It needs urgent drainage of the kidney, not antibiotics alone, and it can become life-threatening within hours.
• Passing little or no urine, or severe pain in a man with a single functioning kidney or a transplanted kidney.
• Pain with persistent vomiting that prevents you keeping fluids down.
• Suspected stone in pregnancy, which needs assessment by a team rather than a standard pathway.

In Thailand the emergency number is 1669. Everything below assumes you are not in one of these situations.

что такое ударная волна

To understand how we break kidney stones without a single incision, we must first understand the physics of the shockwave. In scientific terms, a shockwave is a sharp change of pressure in a narrow region traveling through a medium such as air or water. These waves are typically caused by explosions or by bodies moving faster than the speed of sound.

In urology, we harness this energy and aim it with precision. Think of it like a focused beam of sound energy: much like a magnifying glass focuses sunlight onto a single point to create heat, an ESWL machine focuses shockwaves onto a kidney stone to create mechanical stress, eventually shattering the stone into dust or small fragments that can be passed naturally in the urine.

Удивительная история: от полей сражений до больниц

История экстракорпоральной ударно-волновой литотрипсии (ЭУВЛ) является классическим примером технологии двойного назначения — когда открытие в одной области полностью меняет другую.

• Связь со Второй мировой войной: Во время Второй мировой войны было замечено, что моряки и солдаты, находившиеся поблизости от подводных глубинных бомб, получали тяжелые травмы легких, даже не имея видимых внешних повреждений. Это доказало, что ударные волны могут распространяться через воду и человеческое тело, поражая внутренние структуры.
• «Прорыв» (1980): Десятилетия исследований в области физики высоких энергий в конечном итоге привели к прорыву в медицине. 7 февраля 1980 года в Германии была проведена первая в мире процедура лечения человека с использованием литотриптора экстракорпорального ударно-волнового действия первого поколения. Это событие навсегда изменило урологию, превратив ранее сложные открытые операции в неинвазивные процедуры.

The Four Generations of ESWL

The technology has evolved rapidly since 1980. Each generation of machines has aimed to make the treatment safer, more comfortable, and more accurate. One caution before the list, because it is easy to read a story of generations as a story of steadily better results: what improved most across the generations was comfort, size, cost and targeting. Stone clearance itself has not improved in the same straight line, and the characteristics of your stone matter more than the age of the machine.

1. The First Generation: The Water Bath Era

Ранние машины были массивными. Чтобы работать, пациента приходилось погружать в большую ванну с водой, чтобы ударные волны могли проходить от генератора в тело. Недостатки были существенными: эти машины были невероятно дорогими и огромными, зона фокусировки (область, куда попадает энергия) была широкой и, следовательно, менее точной, пациентам требовался общий наркоз, и обычно они нуждались в госпитализации.

2. The Second Generation: The Dry Patient

Engineers replaced the giant water tub with a small water-filled cushion or bellows pressed against the patient’s skin. The patient stayed dry, and the focal zone became tighter and more accurate. Some treatments could be done under local anesthesia — but the machines remained large and still required significant radiation exposure for stone targeting.

3. Третье поколение: Компактная эффективность

These machines became much smaller and more mobile. However, they still relied heavily on X-ray (fluoroscopy) for targeting, meaning patients were exposed to radiation. Furthermore, the patient’s breathing caused the kidney stone to move up and down with each respiration, making it difficult to maintain a perfect hit rate on the stone. This is the generation in use at Bangkok Hospital Headquarters today, and it remains a thoroughly established treatment — the large majority of the world’s published ESWL evidence was generated on machines of this type.

4. The Fourth Generation

This generation represents a real advance in targeting and patient comfort. I introduced Cambodia’s first 4th-generation lithotripter at Royal Phnom Penh Hospital in 2018, after training on the system at Chang Gung Memorial Hospital in Taiwan. At Bangkok Hospital Headquarters, ESWL is currently performed using a 3rd-generation lithotripter. The improvements of the 4th generation are these:

• Automated stone localization: the system assists in finding and holding the target.
• Radiation-free targeting: ultrasound rather than X-ray can be used to locate the stone, so a session can be completed without radiation exposure. In practice X-ray is still used in some cases, for example where the stone is not clearly seen on ultrasound.
• Respiratory tracking: the ultrasound system follows the stone as it moves with the patient’s breath, so more of the shockwaves land on the target rather than on surrounding tissue.
• Less need for anesthesia: many patients tolerate treatment with little or no analgesia and return home the same day. This is about comfort during the session; it does not by itself mean more stones are cleared.

Что определяет успех?

Whichever generation of lithotripter is used, whether a stone breaks depends far more on the stone than on the machine:

Разделить	Описание
Stone hardness	Not all stones are alike. CT scanning measures stone density in Hounsfield Units. Dense stones — calcium oxalate monohydrate and cystine in particular — resist shockwaves and may not fragment at all, whichever machine is used.
Stone location	Stones in the kidney or upper ureter generally do better than those in the lower pole, where fragments must travel uphill to leave the kidney and often simply stay there.
Stone size	Stones under 10 mm do best. Above 10 mm, a single session clears fewer stones and a second treatment is more often needed.
Body habitus	The distance from skin to stone matters. Where that distance is large, the shockwave arrives with less energy and success falls — which is why ESWL is not the right choice for every patient.

A note on the success figures quoted for ESWL, including on this site in the past. Published rates for stones under 10 mm are often given as roughly 85–90%, but those numbers move a great deal depending on what is being counted. Being stone-free on a CT scan is a far stricter test than having no fragment larger than 4 mm, and studies use both. Density, location and skin-to-stone distance shift the figure further. The honest way to use a published rate is as a starting point for a conversation about your own stone, not as a promise.

What ESWL Asks of You: Risks and Aftermath

Non-invasive does not mean without consequence, and a history of the technology would be incomplete without saying what the treatment actually involves for a patient. Expected effects in the days afterwards include blood in the urine, bruising or tenderness of the skin over the treated side, and colicky pain as fragments make their way down the ureter — that pain can be worse than the original stone, and it is normal rather than a sign of failure.

The complications worth knowing about are:

• Steinstrasse — literally a street of stones: fragments lining up and blocking the ureter. Increasing pain, or any pain accompanied by fever, after treatment needs assessment rather than waiting.
• Инфекционное заболевание, including sepsis from bacteria released as the stone breaks up. This is why a urine infection is treated before treatment, never during it.
• Bleeding around the kidney (perirenal haematoma) — uncommon, and more likely with uncontrolled blood pressure or a bleeding tendency.
• Incomplete fragmentation, needing a second session or a change of plan to ureteroscopy.

ESWL is not suitable for everyone. It is avoided in pregnancy, with an untreated urinary infection, with a bleeding disorder or anticoagulation that has not been managed beforehand, where there is an obstruction below the stone that would prevent fragments passing, and where an aortic or renal artery aneurysm sits in the shockwave path. Whether you can safely pause a blood thinner is a decision for the doctor who prescribed it, together with your urologist — never a decision to make on your own.

What happens after treatment is set out in detail in my patient instructions for 3rd-generation ESWL, which is the machine used at Bangkok Hospital Headquarters. And because breaking a stone is not the same as solving the problem, the more important half of stone care is preventing the next one — and for one stone type in particular, medication can dissolve the stone rather than break it.

Заключительные мысли

The evolution of ESWL — from a wartime observation to a 4th-generation tracking system — is a testament to the power of medical innovation. My presentation in 2018 at Royal Phnom Penh Hospital was, in many ways, a celebration of this progress. But the lesson I took from it, and still hold, is that the machine is the least interesting variable. Whichever generation of lithotripter is used, ESWL remains a non-invasive, same-day treatment that allows most patients to return to normal life quickly — and careful patient selection matters far more than the age of the equipment. At Bangkok Hospital Headquarters, ESWL is performed using a 3rd-generation lithotripter, with candidates selected on the basis of stone size, location, density and body habitus. For stones that ESWL cannot handle well, flexible ureteroscopy with holmium laser (RIRS) is generally the better answer.

If you are dealing with kidney stones and would like to discuss which treatment is right for you, Dr. Soarawee Weerasopone provides specialist kidney stone care у Головной офис Бангкокской больницы and at Samitivej Sriracha Hospital, Chonburi — 088-022-1445.

Телемедицина больницы Бангкока доступна для пациентов, которые не могут прийти лично, включая иностранных пациентов — организуйте это заранее по электронной почте в отделении урологии bhquro@bdms.co.th. Samitivej Sriracha is in-person only. For any enquiry about the cost of consultation or treatment, please contact the hospital directly — Bangkok Hospital at bhquro@bdms.co.th, or Samitivej Sriracha on 088-022-1445.

Часто задаваемые вопросы об УВЛ

Ударно-волновая литотрипсия (УВЛ) — это неинвазивная процедура, используемая для разрушения камней в почках, желчном пузыре или мочеточнике. Она использует сфокусированные ударные волны для разрушения камней на более мелкие фрагменты, которые затем могут быть выведены из организма естественным путем. Процесс включает в себя следующее: 1. **Генерация ударных волн:** Специальный аппарат, называемый литотриптором, генерирует ударные волны. Существует несколько типов литотрипторов, включая электрогидравлические, электромагнитные и пьезоэлектрические. 2. **Фокусировка ударных волн:** Ударные волны фокусируются на камне с использованием визуализации, такой как рентген или ультразвук. Цель состоит в том, чтобы точно направить энергию на камень, минимизируя при этом воздействие на окружающие ткани. 3. **Разрушение камня:** Когда сфокусированные ударные волны достигают камня, они создают микротрещины в его структуре. При многократном воздействии эти трещины увеличиваются, вызывая разрушение камня на более мелкие частицы. 4. **Выведение фрагментов:** Эти более мелкие фрагменты камня затем проходят через мочевыделительную систему и выводятся из организма с мочой. Пациентам обычно рекомендуют пить много жидкости, чтобы помочь в этом процессе. УВЛ обычно проводится амбулаторно и не требует разрезов. Основные преимущества включают отсутствие необходимости в хирургическом вмешательстве, короткий период восстановления и меньший риск осложнений по сравнению с традиционными хирургическими методами.

ЛИТШ (Литотрипсия ударными волнами) использует сфокусированные ударные волны, генерируемые вне тела, для разрушения камней в почках на мелкие фрагменты. Ударные волны проходят через кожу и ткани, концентрируя свою энергию на камне, чтобы разбить его на части, достаточно мелкие, чтобы они могли естественным путем выводиться с мочой.

What are the risks of ESWL, and when should I seek help after treatment?

Blood in the urine, skin tenderness over the treated side and colicky pain as fragments pass are expected in the days afterwards. The complications to know about are steinstrasse (fragments blocking the ureter), infection including sepsis, bleeding around the kidney, and incomplete fragmentation needing a further session. Seek care urgently for fever or shaking chills, pain that is escalating rather than settling, persistent vomiting, or passing little or no urine. In Thailand the emergency number is 1669.

Who should not have ESWL?

ESWL is avoided in pregnancy, with an untreated urinary infection, with a bleeding disorder or anticoagulation not managed in advance, where an obstruction below the stone would stop fragments passing, and where an aortic or renal artery aneurysm lies in the shockwave path. Very dense stones and a large skin-to-stone distance also make ESWL a poor choice, and flexible ureteroscopy with holmium laser is often better in those situations. Never stop a blood thinner on your own — that decision belongs to the doctor who prescribed it.

Является ли ДЛТ болезненной или требует ли она анестезии?

ESWL is generally well tolerated and is performed as a same-day procedure. How much pain relief is needed depends partly on the machine: with 4th-generation systems many patients need no anesthesia at all, while with 3rd-generation lithotripters — including the one used at Bangkok Hospital Headquarters — short-acting intravenous analgesia or light sedation is commonly given. In either case, patients normally return home the same day.

Ударно-волновая литотрипсия (УВЛ) при камнях в почках наиболее эффективна для камней размером до 2 сантиметров.

Stones under 10 mm respond best. Published success rates for this group are often quoted around 85–90%, but the figure depends heavily on how success is defined — being completely stone-free on CT is a much stricter test than having no fragment above 4 mm — and on stone density, position and skin-to-stone distance. Stones above 10 mm may still respond but more often need a second session or a different approach.

Использует ли современный УВЛ всё ещё рентгеновское излучение?

It depends on the generation of the machine. Fourth-generation systems can localize the stone with ultrasound and complete a session without X-ray, although fluoroscopy is still used in some cases where the stone is not clearly visible. Third-generation lithotripters — including the one used at Bangkok Hospital Headquarters — rely on X-ray fluoroscopy for targeting, although exposure is brief and kept as low as reasonably achievable, and the dose is comparable to routine diagnostic imaging.

Is a newer machine always better?

Not in the way the word generation suggests. What improved most across the four generations was patient comfort, machine size and cost, and the accuracy of targeting. Stone clearance did not improve along the same straight line, and it depends far more on the density, size, position and depth of your particular stone. A well-selected patient on a 3rd-generation machine will do better than a poorly selected one on a 4th-generation machine.

Отказ от ответственности: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. No diagnosis, advice or prescription is provided through personal messaging channels or social media. Always consult a qualified healthcare professional before starting, stopping or changing any medical treatment.