How noninvasive stone therapy could shift early intervention

In this video, Mathew D. Sorensen, MD, MS, FACS, a professor of urology at the University of Washington and director of the Comprehensive Metabolic Stone Clinic at the Puget Sound VA, discusses how Break Wave technology could reshape the management of ureteral and renal stones, particularly by reducing reliance on ureteral stents and shifting the balance between surveillance and early intervention.

Regarding symptomatic obstructing ureteral stones, Sorensen emphasizes that current American Urological Association (AUA) guidelines remain clear: Patients with infection or severe illness require urgent drainage with a nephrostomy tube or ureteral stent and are not candidates for immediate stone treatment. However, for stable patients presenting to the emergency department with severe, medication-refractory pain—whose stones are visible on ultrasound—Break Wave may offer a treatment alternative that avoids stenting. Sorensen notes that stents are often the primary driver of postoperative discomfort and recovery burden. Patient-reported outcomes from clinical studies are encouraging, with roughly 97% of participants indicating they would choose the therapy again, and over 90% preferring it to prior shock wave lithotripsy or ureteroscopy experiences.

For asymptomatic renal stones, Sorensen said he believes Break Wave could meaningfully influence the long-standing debate between surveillance and early intervention. Historically, clinicians have favored observation to avoid surgery, despite the unpredictability of stone-related events. Because Break Wave is noninvasive, does not require anesthesia, and can be delivered outside the operating room, it lowers the threshold for proactive treatment. This may shift the clinical goal from simply avoiding surgery to also preventing painful, disruptive stone episodes.

Finally, Sorensen highlights the synergy between Break Wave and the Stone Clear device for fragment evacuation. Evidence suggests active fragment clearance can reduce relapse rates by approximately 70% compared with leaving residual fragments behind, underscoring the importance of pairing stone fragmentation with effective clearance.

DISCLOSURE: Sorensen is a member of the scientific advisory board for and has an equity interest in SonoMotion.