الفهرس 
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Abstract
Summary
Patients with Urolithiasis constitute an important part of everyday urological practice. Over years, the open surgery has largely gone down and has been replaced by shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), and ureteroscopy (URS). The clinical introduction of SWL during the early 1980s dramatically changed the management of patients with urinary tract stones. During the more than 20 years since the worldwide dissemination of this technology, the development of new lithotripters, modified indications and principles for treatment, have changed completely the way in which patients with renal stones are treated.
It is thought that SWL may be suitable for more than 90% of uroliths in adults, but success depends on a number of factors:
a. The size and location of the stone (ureteral, pelvic, or calyceal)
b. The composition of the stone although this can be difficult to predict preoperatively.
c. Patient’s habitus – obesity, rather than a simply a high BMI, can cause a lower success rate after SWL, as SWL success depends on where the excess fat is situated. This is partly due to the difficulty in visualizing the urolith on ultrasound or fluoroscopy and also the skin to stone distance may exceed that recommended for the lithotripter.
d. The efficacy of the lithotripter and the factors chosen by the operator.
E. The frequency of SW delivery has important role in SWL success
Each of these factors is influential on the success rate (stone free status) of SWL.
The aim of this study is to compare the efficacy and safety of utilization of ultraslow, full power SWL in comparison with slow rate, full power SWL.
In our study, 320 patients underwent SWL and classified in to 2 groups, G1 were performed at frequency of 60-90 SW/min and G2 were performed at frequency of 30 SW/min and 2 safety pauses were used to increase safety.
The results of our study showed that there is no significant difference between the two groups SWL success (P-value=0.246). SWL success rate in group 1 was 141/160 patients (88.1%), in group 2 was 147/160 patients (91.9%) and was 288/320 patients (90%) in all patients.
We concluded that
The rapid ramping full power protocols with either slow or ultra slow frequency with 2 safety pauses are effective and safe.
Our results are better than that reported especially in stones with high SAV, SSD, BMI, stone size and SWL protocols currently needs to be revised in the face of these findings.
Both of our protocols were comparable but we recommend ultra slow protocol for stones with long SSD> 9 cm as results showed and relatively for stones with SAV ≥1000.
Stones with negative predicators like high SSD, high BMI, large size≥2cm, high SAV can be effectively treated with both protocols with high success rate but better treated with ultraslow protocol with average success rate of 80%.
KUB can be used only for follow up post SWL (without need for NCCT) as it has less cost and less exposure to radiation.