Inside Break Wave: A new noninvasive approach to stone care

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, explains how Break Wave lithotripsy represents a fundamentally different approach to stone fragmentation compared with conventional shock wave lithotripsy (SWL).

Although both technologies use noninvasive sound waves focused through the skin, traditional SWL delivers high–peak pressure, high-amplitude pulses once per second to split stones in half repeatedly. This process can be unpredictable, often leaving patients with multiple residual fragments that may not pass easily.

Break Wave lithotripsy instead uses low-pressure, repeated pulses that generate standing stress waves within the stone. These waves amplify energy inside the stone—up to tenfold—while exposing surrounding tissue to only about one-tenth of the peak pressure used in SWL. Clinically, this translates to more predictable fragment sizes that shed gradually from the stone’s surface rather than breaking into large pieces. Because of the lower tissue-level energy, treatments can be performed without anesthesia and may reduce collateral tissue effects.

Sorensen notes that current clinical use of Break Wave mirrors many of the same contraindications as SWL, including active infection, distal obstruction, pregnancy, bleeding disorders, and anticoagulation. A unique limitation is the requirement for ultrasound visualization: The stone must be visible and targetable by ultrasound to be treated. This makes the mid ureter particularly challenging, though stones in all kidney locations and in the proximal and distal ureter have been successfully treated.

The technology is presently optimized for stones 10 mm or smaller, although larger stones have been treated in select cases. Unlike SWL, Break Wave performance does not appear limited by patient body habitus or skin-to-stone distance, as probes are designed for different depths and account for tissue attenuation. Overall, Break Wave offers a promising, more controlled alternative to conventional lithotripsy with the potential for improved predictability and patient tolerance.

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