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However, SWL\u2019s high-pressure pulses can cause tissue injury, often necessitates some level of anaesthesia, and may require repeated sessions or ancillary treatment to achieve stone free status. Burst Wave Lithotripsy (BWL) emerges as a promising alternative, utilizing multi-cycle, ultrasound bursts at lower pressure amplitude to fragment stones, while minimizing cavitation under real-time imaging in a portable manner.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This scoping review evaluated BWL\u2019s efficacy, safety, and clinical potential. A systematic search identified 19 eligible studies, including in vitro experiments, preclinical trials, and human clinical trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In vitro studies demonstrated BWL\u2019s capability to fragment urinary stones of diverse compositions with high comminution rates. Higher ultrasound frequencies produced smaller fragments (&lt;\u20091\u00a0mm), while lower frequencies resulted in larger fragments (3\u20134\u00a0mm), allowing for controlled fragmentation tailored to clinical needs. Preclinical trials in porcine models showed lower pressure and reduced cavitation, which account for BWL\u2019s safety, causing less associated tissue injury even in anticoagulated subjects. Human trials reported BWL as well tolerated in awake patients with high fragmentation success rates (88\u201391%) and low complication rates. BWL offers distinct advantages, including lower cavitation and tissue injury risks, portability, and anaesthesia-free application. Ongoing trials aim to validate BWL\u2019s efficacy and explore its combined use with ultrasonic propulsion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>BWL represents a paradigm shift in lithotripsy, offering controlled fragmentation, reduced tissue injury, fragment propulsion and portability for office-based or ambulatory care. Early clinical evidence underscores its safety and efficacy, even in anticoagulated patients. While large-scale trials are needed to solidify its role, BWL\u2019s procedural flexibility positions it as a transformative alternative to SWL, poised to redefine urolithiasis management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00345-025-05645-x","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T04:34:09Z","timestamp":1745555649000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Burst wave lithotripsy - a paradigm shift: inferences from a scoping review"],"prefix":"10.1007","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9956-1558","authenticated-orcid":false,"given":"Steffi Kar Kei","family":"Yuen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3740-7141","authenticated-orcid":false,"given":"Vineet","family":"Gauhar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8915-3617","authenticated-orcid":false,"given":"Chu Ann","family":"Chai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0144-4933","authenticated-orcid":false,"given":"Connor M.","family":"Forbes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7225-9298","authenticated-orcid":false,"given":"Victor K. 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