**Author details**

others as pressure ulcers, acute burns, arterial leg ulcers, disturbed wound healing and surgi‐ cal wounds. Several parameters were used to assess the rate and quality of wound healing. They include time to healing, reduction of wound surface area and tissue viability using laser

One of the included studies was done by the same author [20] as a single‐blinded randomized controlled trial on the effect of ESWT in the treatment of chronic diabetic foot ulcers. They used almost the same parameters in measuring the rate of ulcers healing in addition to wound bed preparation. Standardized wound care was given, including wound debridement, blood‐ glucose control agents and special footwear to minimize the pressure. 20 weeks following the last ESWT session, 54% of ESWT group had completely healed ulcers versus 28.5% in the con‐ trol group. There was significant reduction in the healing time with an average of 664.5 days

The complications reported included pain, itching, infection, pigmentation and skin irrita‐ tion. However, these complications were self‐limiting and resolved in 5–7 days [19]. That is the reason why ESWT is recommended as an adjunctive therapy alongside with the standard

The large number of patient treated by SWL in the past 25 years gives an important informa‐ tion about indications, contraindications, adverse effects of the procedures and the required development to improve the techniques of SWL for better treatment and less side effects [31]. Krambeck et al. [32] found that HTN incidence was significantly correlated with bilateral pro‐ cedures done by using a Dornier HM3 lithotripter, while DM was correlated with shock wave number and frequency. The author postulate that occurrence of DM and HTN may be due to unobserved microtrauma on the pancreas and the kidney. Chew et al. [33] compared the inci‐ dence of DM and HTN in patient treated with an unmodified lithotripter HM3 (USWL) and second‐generation modified HM3 lithotripter (MSWL); they found that there was no association between lithotripter and development of either DM or HTN in multivariate analysis and they suggest that the prevalence of DM and HTN in patient with renal stones is due to the presence of metabolic syndrome. Where there is increasing evidence, the patient with renal stones get HTN and DM and vice versa through this syndrome. Lee et al. [34] introduced that SWL treat‐ ment at frequency of 60 shocks/min gave better outcome compared with SWL at 120 shocks/ min. On the other hand, pretreatment did not impact renal injury. Salem et al. compared slow and fast shock wave frequency, delivery rates in disintegrating pediatric renal stones smaller than 20 mm and the impact on stone clearance. Terms of comparison include treatment suc‐ cess, anesthesia time, secondary procedures, cost and efficiency quotient. They found that slow delivery rate of SWL has better stone clearance results than fast delivery rate [5]. Mazzucchi et al. [35] found no significant differences in the stone‐free rate and complications develop‐ ment by reducing the total number of impulses from 4000 to 3000 and the frequency from

**9. Recent trends in extracorporeal shockwave lithotripsy (ESWL)**

Doppler perfusion imaging to measure the blood flow perfusion rate.

114 Updates and Advances in Nephrolithiasis - Pathophysiology, Genetics, and Treatment Modalities

in ESWT group versus 81.17 days in the control group.

wound care program [19, 20].

Noha Maraie, Omar Mohammed Osman and Hosni Khairy Salem\* \*Address all correspondence to: dr\_hosni@yahoo.com Faculty of Medicine, Cairo University, Cairo, Egypt
