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4th Generation ESWL, Really better than the old generation one?

Now days, every modern surgeon aims to do every operation as non-invasively as possible. In the past, kidney stones had be done by open surgery, Luckily right now we have several methods to get rid of the stone without any wound or minimizing the wound. ESWL is one option for stone management we are going to talk about. The first ESWL machine was invented in Germany after World War 2. With the benefits of shockwave sound that can infiltrate into skin without any wound, it has been developed into the 4th generation machine which does not need to be done under anesthesia so the patient can save on unnecessary expenses in terms of the anaesthesiologist team, operative cost and hospital stay.

1st Generation ESWL machine is really big, being the size of around a big truck and the patient needed to be operated on under a full-filled water tank. Definitely, needed the anaesthesia within the water so everything was difficult and nearly impossible to do.

That’s why 2nd generation ESWL machine was invented to solve the problem of staying in a water tank for a long time. With this generation ESWL, the first ever-dry technique, the patient tended to be more comfortable during the procedure. But the cons still exist, for example, the machine was still big, the patient was still not comfortable and needed anesthesia due to the pain.

Commonly practiced all over the world right now,  the 3rd generation ESWL machine is a lot more compact, more comfortable for the patient – allowing them lie down on the bed during operation. However, anaesthesia is still needed due to some shockwave pulse possibly missing the target and causing kidney pain.

Royal Phnom Penh hospital is the first and currently only hospital in Cambodia that has installed this technology. Even in Thailand most ESWL machines are still the previous 3rd generation that need to do shockwave under anaesthesia.

From the original paper from Taiwan, 4th generation ESWL reach 98.5% compared with 3rd generation one at 82.6% shockwave hit rate. The less missed target, the less pain patient will be experience. The pain is minimal so there is no need for any anaesthesia or even pain killers. The 12 mm of stone disappeared at 80% stone free rate within 3 months following up as reported.

With 1 year of experience in this machine, our success rate is around 70% (in every size of kidney stone). Strong patient satisfaction with no serious complications so far. Anyway, there are alternative management for the kidney stone and every procedure has pros and cons. The distinctive pro for 4th generation ESWL is day-care management and it is the least invasive for stone management. Is it worth to try before doing any harmful operation? Any questions you can come to visit me at the Urology clinic.

Dr. Soarawee Weerasopone

Minimally invasive Urologist

Royal Phnom Penh hospital




现今,每位现代外科医生都希望尽量能做无创伤口地进行每项手术。 以前, 肾结石是藉节由通过开放手术完成的,幸运的是,现在我们有几种方法可以除碎结石,而不会造成任何伤口或使伤口极为微小。 体外冲击波碎石 (ESWL) 是我们将要讨论的肾结石处理的第一种选项。 第二次世界大战后,德国发明了第一代碎石机(ESWL)。由于液电式冲击波技术,通过水下放电的方式, 利用火花塞和一个椭圆形反射器,将电能转换成机械能,具有高能量密度的冲击波。从技术上,比较简单方便地就能实现输出不同能量的单脉冲或输出同一特性的多脉冲的变换,但电极损耗较大,因此在发射几千次冲击波(仅数位病患手术)后必须进行更换电极组件。目前,已经发展到第四代碎石机器,手术前无需再打麻醉,可以替患者节省不必要的麻醉费,手术费和住院费。

第一代体外冲击波碎石(ESWL)机器真的很大,大约有一辆大车的大小, 患者需要在注满水的水箱里进行手术。 绝对需要进行麻醉,所有操作都很困难,几乎无法完成。

第二代体外冲击波碎石(ESWL)机器的发明就是为了解决长时间在水箱中治疗的问题。 这一代的体外冲击波碎石(ESWL)机器使用了从未有过的干式技术,患者在手术过程中往往会比较舒适些,但是,缺点仍然存在比如说机器还是很大,在治疗当中,患者仍然不舒服,并且还是需要打麻醉缓解疼痛。

现在在世界各地都普遍使用第三代体外冲击波碎石(ESWL)机器,它的尺寸减小了许多,可以让患者在手术过程中更舒适的躺在床上进行治疗。 但是,一部分的冲击波会丢失结石目标并导致肾脏疼痛,因此仍需要麻醉。

金边皇家医院是柬埔寨第一家也是目前唯一一家安装了第四代体外冲击波碎石技术的医院, 即使在泰国,大多数体外冲击波碎石(ESWL)机器仍是需要在麻醉下进行手术的前三代机器。

从台湾的原始论文来看,第三代体外冲击波碎石(ESWL)达到 82.6%的碎石率,第四代体外冲击波碎石(ESWL)则可达到 98.5%的碎石率,因此,患者经历的痛苦越少,疼痛也是最轻的,所以不需要用任何麻醉或者止痛药。 根据报导,12毫米以下的结石在 三个月内达到了 80%的结石消失率。

凭借该该机器使使用一年后的经验,在各种大小的肾结石中,我们的成功率约为 70%。 到目前为止,患者满意度很高,也没有严重的并发症。 总之,肾结石有其他治疗方法,每个方法都有其优缺点。 第四代体外冲击波碎石(ESWL)的独特优点包含对肾结石碎石处理后的损伤最小且无伤口,不需要住院、不需要打麻醉药等。 在进行任何有害操作之前是否值得尝试? 如有任何问题可以来我们医院泌尿外科看诊喔!

Soarawee Weerasopone 医生 微创泌尿科医生 曼谷皇家医院









台湾の学術論文の原文によると、第3世代ESWLの衝撃波命中率の88.5%と比較して、第4世代は98.5%に達しました。標的の結石を見逃すことが少なくなるほど、患者様の痛みは少なくなります。痛みは最小限なので、麻酔や鎮痛剤さえ必要ありません。12 mmの石は、3ヶ月以内に80%の無結石率で消失したと報告があります。


Dr. Soarawee Weerasopone

低侵襲性医療 泌尿器科専門医

Royal Phnom Penh hospital