**8. ESWT and chronic wound healing**

pancreatitis or no need for surgical treatment for chronic pancreatitis. There were no signifi‐ cant differences in success rates between patients who received ESWL alone and those who

ESWL sources used for salivary stones lithotripsy are either the electromagnetic source or the piezoelectric source. The electromagnetic shock wave source is more commonly used for being minimally invasive without need for anesthesia, so it can be done as an outpatient practice [26, 27]. Capaccio et al. [13] have done a prospective study on 415 patients on two groups in two time periods. Both groups received ESWL via an electromagnetic device that was preceded by ultrasonography (US) for localizing the stones. Follow‐up was done using ultrasonography at 1 week, then at 1, 3, 6 and 12 months after ESWL application. Complete stone clearance percentages were generally higher in patients with parotid duct stones (group A: 69.3% and group B:68.8%) than in those with submandibular duct stones (group A: 35.9% and group B: 48.8%). However, with US follow‐up, some residual submandibular and parotid dust stones were observed. Post‐ESWL procedures to remove the symptom‐ atic residual stones included sialendoscopy or transoral removal of stones. This proved that ESWL achieves good results for salivary stones especially parotid duct stones with small

In another retrospective study by Schmitz et al. [14], 31% of patients reached total stone clear‐ ance, and in 55% of patients, the treatment was partially successful with asymptomatic resid‐

In spite of being non‐invasive efficient alternative to surgery in management of sialadeni‐ tis, ESWL is contraindicated in the following cases: acute sialadenitis, gingivitis, pregnancy, bleeding disorders and calculi that cannot be detected using US. Relative contraindications

Several trials studied the efficacy of ESWT in the treatment of ED. Clavijo et al published a systematic review and meta‐analysis of seven randomized clinical trials with 602 patients with vascular ED [15]. The seven studies used low‐intensity shockwave therapy (Li‐ESWT) for ED and used the erectile function domain of the International Index of Erectile Function (IIEF‐EF) to assess the response to treatment. The IIEF‐EF is a validated questionnaire that includes six questions about erectile frequency, firmness, penetration ability, frequency of maintenance, ability to maintain erection and erectile confidence on a scale of zero to five [28]. The difference in IIEF‐EF score pooled change was measured in patients with ED treated with Li‐ESWT and compared to that measured in patients treated with sham therapy. The IIEF‐EF score in ESWL group was 6.40 points compared to the sham group which was 1.65 [15].

ual stone identified using US. Failure of treatment occurred in 14% of cases.

include patients with cardiovascular diseases or artificial pace makers [13, 14].

**6. ESWT in the treatment of erectile dysfunction (ED)**

received adjuvant ERCP.

diameters.

**5. ESWL in the treatment of salivary stones**

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

A recent systematic review done by Omar et al. [19] included 11 studies about the role of ESWT in the treatment of chronic wounds of lower limbs. A total of 925 patients were enrolled. About 85% of them received ESWT, and 15% represented the control group. Chronic wounds included diabetic foot ulcers (39.6%), traumatic wounds (20.3%), venous leg ulcers (12%) and 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 Doppler perfusion imaging to measure the blood flow perfusion rate.

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 in ESWT group versus 81.17 days in the control group.

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 wound care program [19, 20].
