Extracorporeal Shock Wave Lithotripsy (ESWL) is the use of low-frequency, high-energy shock waves, externally sent through the skin to target kidney stones – causing the stones to break down into fragments until they become "stone dust", small enough to pass through urination.
ESWL is a non-invasive procedure that allows patients a very short stay at the hospital and a quick recovery.
Indications for Treatment
ESWL is used for the treatment of urinary tract stones – especially stones in the kidney and the ureter, however, is generally not used to treat bladder stones. Patients often see the doctor when experiencing the following symptoms:
- Abdominal or lower back pain
- Urinary abnormalities, similar to the symptoms of cystitis, such as frequent urination, pain or burning during urination, or the presence of blood in urine, etc.
- Inability or difficulty urinating, or interrupted urine flow.
- The presence of small, gravel-like stones mixed in with urine
- Urinary tract infection, with fever.
Once urinary tract stones have been diagnosed, the doctor will consider whether or not the patient should undergo ESWL. The decision will be based on a variety of factors such as the location and size of the stones, density of the stones, any inflammation or swelling of the kidneys, the patient’s overall health, and whether or not the patient will be able to handle the intensity of the shock waves.
The patient will receive a physical examination and undergo the standard preparations for surgery. The patient will be then be anesthetized.
Equipment involved in the procedure:
- X-ray that allows physicians to pinpoint the exact location of the stones in real-time
- Monitor that displays the x-ray images
- Lithotripter , a device that sends shock waves through the patient's body to break up stones
- Specially designed treatment bed to accompany the lithotripter machine.
The lithotripter will administer approximately 8,000-10,000 shockwaves before stones are broken down into "stone dust". The process takes about 1 hour and 30 minutes to complete.
Limitations of ESWL
Although ESWL is a widely popular and effective treatment method, not all types of urinary tract stones can be treated using this method.
Limitations are as follows:
- Stones which are too large (kidney stones larger than 2 centimeters / ureteral stones larger than 1-1.5 centimeters)
- Patients with bacterial infection and inflammation of the urinary tract (which needs to be cured prior to the procedure in order to avoid worsening the infection)
- Patients with bleeding disorders
- Patients with a urinary tract obstruction (must first be corrected)
- Patients who are overweight, obese, or pregnant
Complications of ESWL
Complications of ESWL are usually relatively mild; patients may experience the following symptoms:
- Blood is mixed in with urine causing a reddish color, but will gradually fade after urinating 2-3 times.
- There may be an increase of inflammation in patients with a pre-existing infection, but can be treated with antibiotics.
- There may be some abdominal pain in cases where stone fragments migrate and cause blockage in the urethra – which will pass normally as well.
- Nearby organs such as the intestines, arteries, and veins, may sustain some minor injuries.
- Drink plenty of water in order for stone fragments to pass during urination.
- Take medications according to doctor's orders.
- Go for periodic follow-up visits, staring within 1-2 weeks after the procedure, to ensure that all the stones have passed completely, and to prevent recurrence.
Alternative Treatment Options
If the doctor decides that ESWL is not suitable for the patient, other treatment options may be suggested, including:
- Percutaneous Nephrolithotomy (PCNL) – A small incision is made through the skin, in which a nephroscope (a miniature fiber optic camera) and other surgical instruments are inserted and used to break stones into small pieces and suction them out.
- Surgical Removal - Surgery is required for jackstones (jackstone calculi), stones that have the specific appearance of radiating spicules, or stones that are abnormally large. These kinds of stones are impossible to remove through other methods.
- Cystolitholapaxy – A cystoscope is inserted into the urethra to break up the stones into smaller fragments, which can then be passed though urination.
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