Table 6.

Therapeutic recommendations for extracorporeal shock wave lithotripsy (energy level for the Siemens LITHOSKOP)

Stone size, mm	Location	No. of shock waves	Energy level*	Frequency, shock waves/min	Comments
5–10	Kidney	3000–3500	Ramping: 100 shock waves with Level 0.1–1	60	Check BP (maximum systolic BP: 140 mm Hg)
			Afterwards, maximal level:		Retreatment after 2–3 d
			Lower calyx: 3.0
			Upper and middle calyx: 3.5
			Pelvis: 4.0
	Ureter	3500–4500	No dose escalation (ramping)	Upper and middle ureter: 90	Retreatment after 2 d
			Maximal Level:		Minimal movement of distal ureteral stone
			Upper ureter: 4.0	Distal ureter: 120
			Middle ureter: 6.0
			Distal ureter: 8.0
10–20	Kidney	Single stone: 3500	Ramping: 100 shock waves with level 0.1–1	60	Check BP (max. systolic BP: 140 mm Hg)
		Multiple stones: 4000 (ie, 2 × 2000)
			Afterwards, maximal level:		Start with the smallest stone Retreatment after 2–3 d
			Lower calyx: 3.0
			Upper and middle calyx: 3.5
			Pelvis: 4.0
	Ureter	4500	No dose escalation (ramping)	Upper and middle ureter: 90	In case of no stent, start at the upper rim
			Maximal level:
			Upper ureter: 4.0	Distal ureter: 120	Minimal movement of distal ureteral stones
			Middle ureter: 6.0
			Distal ureter: 7.0

BP = blood pressure.

^*8–117 mJ/impulse (measured by light-spot hydrophone).