New strategies and protocols in SWL.

An update of the new treatment strategies in extracorporeal lithotripsy as a valid therapeutic alternative in the management of urinary calculi. We performed a search and review of the most recent literature which responded to the terms "best practices", "update", "optimization", "practice pattern" in lithotripsy. Only articles written in English or Spanish were selected. The use of a stepwise voltage ramping during extracorporeal lithotripsy with or without pause before the first rise of energy, a decreased delivery rates and the use of a higher number of shock waves per session are shown as alternatives to improve the effectiveness with optimum safety profile. Extracorporeal lithotripsy is still an effective and minimally invasive treatment, and it has an important role in the treatment of urolithiasis. New treatment strategies are being developed to increase the effectiveness with a similar safety profile.