Extracorporeal shock wave lithotripsy (ESWL)

Overview

Extracorporeal Shock Wave Lithotripsy (ESWL) is a prevalent, non-invasive procedure utilized for the treatment of kidney stones. This method employs high-energy shock waves to fragment stones, facilitating the passage of small stone fragments through the urinary tract, thereby expelling them from the body more effortlessly.

Kidney stones, solid formations resembling rocks, develop when there are elevated levels of specific substances, such as calcium, in the urine. They originate within your kidneys but have the potential to move into your ureters, the ducts responsible for transporting urine to your bladder.

While many kidney stones naturally pass through the urinary tract and are expelled through urination, larger stones may become obstructed, causing significant pain during a “kidney stone attack” when they lodge in the ureter, impeding the drainage of urine from the kidney.

ESWL effectively dislodges these stones, facilitating their eventual passage through the urinary tract without the need for surgical intervention.

Reasons for undergoing the procedure

ESWL is frequently employed by doctors for the management of kidney stones that:

• Have a diameter of more than 5 millimeters, or roughly the size of a pencil eraser, making them too big to pass by themselves.
• Cause a blockage in urine flow.
• Cause severe pain.

When suggesting a procedure for kidney stone treatment, healthcare providers take into account:

• The stone’s dimensions. For smaller stones, ESWL typically works best.
• Where the stone is located.
• Any medical conditions you have or medications you take regularly.
• The body type. Anatomical variations may cause the stone and the shock waves to be farther apart. As a result, ESWL may be less successful.

Risks

Possible risks associated with ESWL comprise:

• Infection
• Bleeding
• Obstruction in your ureter

Before the procedure

Your doctor will provide instructions on preparing for ESWL. You might be required to:

• Take a urine or blood test. Urine (pee) tests to screen for Urinary Tract Infections (UTIs) and blood tests to assess your kidney function and blood counts may be required.
• Go over your prescriptions with your doctor. Take all of your drugs as prescribed until your doctor instructs you to stop. Warfarin or other blood-thinning drugs may need to be stopped. These drugs may make the procedure-related bleeding risk higher.
• A several hours prior to your surgery, stop eating and drinking.
• Make plans for a ride home following the surgery from someone.

During the procedure

Prior to undergoing ESWL, anesthesia will be administered by the doctor to ensure your comfort. During the procedure, you might either be asleep, awake but drowsy, or have regional anesthesia, wherein you’ll be awake but numb from the waist down.

• You’ll be positioned on a padded table resting on a water-filled cushion. Alternatively, you might be seated within a sizable water-filled tub.
• Doctors will utilize X-rays or ultrasound to accurately locate the stone. These images assist in precisely directing shock waves towards the stone.
• Your doctor may make slight adjustments to align your body with the energy beams.
• A shock wave lithotripsy apparatus transmits potent energy waves through the water and into your body. If you are conscious during the procedure, you might perceive a popping sound or sensation of tapping along your side.
• Numerous shock waves are targeted at the kidney stone, fragmenting it into multiple pieces.

ESWL typically lasts around an hour. However, the duration of your procedure may vary depending on factors such as the size and quantity of kidney stones you have, as well as your general health condition.

ESWL typically doesn’t necessitate a hospital stay, as it’s an outpatient procedure. You’ll be discharged on the same day, though plan to spend several hours in the recovery area before heading home.

Outcome

The majority of individuals typically resume their normal activities within a few days following ESWL. However, you may experience lingering side effects until your body has expelled all remaining stone fragments. Throughout the recovery period from ESWL, you might encounter side effects such as:

• Pain. In the vicinity of the treatment region, you can feel stiff or sore. Some report having little bruises down their sides.
• Blood in the urine. Small amounts of blood (pink-tinged pee) are a normal occurrence.
• Urinating in agony.

Typically, these symptoms dissipate within a few days.

After the procedure, anticipate passing kidney stone fragments in your urine for a period ranging from several days to weeks. These stone pieces may resemble sand, gravel, or dust.

You should expect to experience some discomfort as the stone fragments pass. Pain may fluctuate until all the kidney stone pieces have been expelled from your body.

To aid in the passage of the stone and alleviate pain, your doctor may prescribe:

• Tamsulosin. This medication helps relax your bladder and facilitates the passage of the stone through urination.
• Ketorolac. This medication is a prescribed pain reliever.

Follow the prescribed dosage for any medications provided. Additionally, you might find relief by taking Over-The-Counter (OTC) pain medication to manage discomfort until all stone fragments have been passed. Ensure to consult your doctor regarding the safety of OTC medications for your condition.

Urination after lithotripsy

You may experience discomfort while urinating for a few days following shock wave lithotripsy. Passing stone fragments, even small ones, can be painful at times, sometimes significantly so. Consult your doctor regarding what to anticipate and when to inform them about any painful urination.

The success rates of ESWL vary considerably, ranging from 30% to 90%. Success can depend on factors such as:

• The kind of stone.
• The body type.
• The stone’s dimensions.
• The position of the stone.

Your likelihood of success increases if the kidney stone is located within specific regions of your kidney or the upper portion of your ureter.