(ESWL) Extracorporeal shock wave lithotripsy is a special use of kidney ultrasound, where high intensity focused ultrasound pulses are used to break up calcified stones in the kidney, bladder, or urethra. Pulses of sonic waves pulverize dense renal stones, which are then more easily passed through the ureter and out of the body in the urine. The ultrasound energy at high acoustic power levels is focused to a point exactly on the stone requiring an ultrasound scanning gel for maximum acoustic transmission.
Air bubbles in the ultrasound couplant, regardless of their size, degrade the performance of Lithotripsy and have the following effect:
Air bubbles smaller that 1/4 wavelength cause scattering of the sound waves as omni directional scatterers and less acoustic energy reaches the focal point. The result is less acoustic power at the focal point to disintegrate the kidney stone.
Air bubbles larger than 1/4 wavelength act as reflectors and deflects the acoustic energy off in a different direction. These results in less acoustic energy at the focal point.
Microbubbles dispersed throughout the ultrasound couplant layer change the average acoustic impedance of the gel layer (which reduces the total transmitted energy) and, due to refraction, change the focal point.

Ultrasound therapy uses high energy sound waves to treat different diseases. Historically, the use of ultrasonic waves in therapy began before the wide use as a diagnostic medical imaging tool. Dependend on the intensity, ultrasound therapy reach from the thermal effect used in physical therapy to the destruction of tissue with lithotripsy.

Types of ultrasound treatment:
See also Thermal Index, History of Ultrasound, Interventional Ultrasound, and B-Mode Acquisition and Targeting.

(HIFU / FUS) High intensity focused ultrasound is used in thermotherapy or thermoablation e.g., for the treatment of benign prostate hyperplasia or under study for the treatment of cancer.
An applied ultrasound probe (see transrectal sonography) focuses sound waves at one spot, elevating the tissue temperature to a point that the tissue destroys. Generally, lower frequencies (from 250 kHz to 2000 kHz) are used than for medical diagnostic ultrasound, but significantly higher time-averaged intensities.

See also Magnetic Resonance Guided Focused Ultrasound, Low Intensity Pulsed Ultrasound, and Lithotripsy.

Ultrasonography of the kidneys (renal ultrasound) is part of a complete examination of the abdomen. Ultrasound is used to determine the size, shape, and exact position of the kidneys. Renal ultrasound provides important information regarding kidney function, related blood vessels, kidney stones, renal cysts, tumors, or hydronephrosis (suggestive of obstruction or blockage of the kidney).
The kidneys are scanned on longitudinal and transverse planes. Patients should avoid carbonated drinks such as soda or seltzer the day before, and have a full bladder for the test.
Lithotripsy is a therapeutic ultrasound procedure used to shatter simple stones in the kidney or upper urinary tract.

See also Urologic Ultrasound, Reflux Sonography.

Transurethral echography or sonography is used to detect small tumors of the urinary bladder or to visualize the urethra and surrounding muscles with special transducers. The bladder neck can be visualized using a transrectal probe.
In addition, high intensity focused ultrasound provides treatment of benign prostatic hyperplasia and adenocarcinoma of the prostate. Small catheter-based sectored tubular or planar transducers with highly directional energy deposition and rotational control are used for precise treatment. Regions of the prostate can be selective coagulatet while monitoring and controlling the treatment with MRI.

See also Urologic Ultrasound, Lithotripsy, Reflux Sonography, Ultrasound Therapy, Interventional Ultrasound and Thermotherapy.