Contemporary practice patterns of shock wave lithotripsy in the era of endourology: an international FUTURE survey.

The relative use of shock wave lithotripsy (SWL) has declined with the expansion of endourological techniques, although SWL remains widely available. Contemporary international data on SWL utilization, technical delivery, operator models, outcome assessment, and artificial intelligence (AI)-based tools are limited. This study evaluated current SWL practice patterns among urologists involved in stone disease management. A cross-sectional web-based survey was developed by the Kidney Stones Pillar of the FUTURE collaborative group and distributed through the Endourological Society network and X platform between February and April 2026. The questionnaire assessed SWL utilization, decision-making, technical parameters, operator profile, follow-up, outcome definitions, and AI use. Results were summarized using item-level denominators. Exploratory subgroup analyses compared respondents with higher (> 15%) versus lower/no (≤ 15%) SWL utilization. A total of 156 responses from 36 countries were analyzed. Overall, 121/156 (77.6%) respondents used SWL in ≤ 15% of stone cases, including 26/156 (16.7%) who did not currently use SWL. Among 144 respondents for whom the temporal-trend question was applicable, 89/144 (61.8%) perceived a decrease in SWL use over the preceding three years. Higher SWL utilization was associated with in-house SWL availability [30/35 (85.7%) vs. 59/121 (48.8%), p < 0.001]. Electromagnetic lithotripters were most common [66/129 (51.2%)], and 100/126 (79.4%) respondents reported equipment aged ≥ 6 years. AI access remained limited, with 107/130 (82.3%) reporting no access and 11/130 (8.5%) reporting clinical use. Among respondents to this international survey, SWL was used in a minority of stone cases and was commonly perceived to have decreased over the preceding three years. Considerable variability was observed in patient selection, treatment delivery, operator models, training, and outcome assessment, while access to AI-based tools remained limited.