Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. Among the Cochrane Reviews of treatments to help patients with kidney stones, our review comparing shock wave treatment with surgery was updated for the second time in August 2023. Here's lead author, Vasun Setthawong from Rangsit University in Bangkok, Thailand to tell us about the latest findings.

Vasun: Kidney stones form in the kidneys, and people who drink too little water, have a poor diet, are overweight, have certain medical conditions, or use certain medicines are more likely to get them. The stones can cause pain, kidney infection, and kidney failure and various treatments are used to remove them. These include extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS). We set out to compare all three techniques in this review, and I will begin with a brief explanation of each.
ESWL uses shock waves from outside the body to break a stone inside the kidney into tiny pieces without cutting the skin. The broken stone fragments are then small enough to pass out in the urine. PCNL is a surgical method of removing kidney stones that involves inserting a small tube through the skin to the kidney, breaking up the stones using different instruments (such as laser and ultrasound), and removing the fragments through the tube. RIRS is another type of surgery, which involves placing a small viewing tube through the urethra and ureter into the kidney, then crushing or evaporating the stone or grabbing and removing it with small pincers.
We were interested in the comparative effects of the techniques on treatment success, quality of life, complications, length of hospital stay, and other outcomes important to people with kidney stones.
For this update of the review, we included 31 randomized trials involving nearly 3400 people, with the largest study having 649 people and the smallest having just 30.
We found that ESWL may have lower treatment success after three months than PCNL, but the two procedures may have similar effects on quality of life and ESWL probably leads to fewer complications than PCNL.
Compared with RIRS, ESWL may have lower treatment success after three months, but we are very uncertain about whether there are important differences on quality of life and unwanted effects.
On this basis, for people at high risk for surgery or anesthesia, we concluded that ESWL may be a viable treatment; while PCNL or RIRS may be preferable for people who can tolerate anesthesia and invasive procedures.

Mike: If you would like to delve deeper into this evidence, the review can be found at Cochrane Library dot com with a simple search for 'shock wave treatment for kidney stones'.