ESWL is the only non-invasive treatment for kidney stones, meaning no incision or internal telescopic device usage.

ESWL involves the administration of a series of shock waves to the targeted stone. The shock waves, which are generated by a machine called a lithotripter, are focused by x-ray/ultrasound onto the kidney stone. The shock waves travel into the body, through skin and tissue, reaching the stone where they break it into small fragments. For several weeks following treatment, those small fragments are passed out of the body in the urine.

We can identify some patients who will be unlikely to experience a successful outcome following ESWL, whereas we may predict that other patients will be more likely to clear their stones.

Advantages of ESWL

The primary advantage is completely non-invasiveness.

Who should be treated with ESWL?

ESWL is well suited to patients with small kidney stones upto 1.5 cm in favourable anatomic locations and upperureteric stones < 1 cm that can be easily seen by x-ray/usg.

ESWL is NOT a particularly good treatment for:

Pregnant patients

Patients on “blood thinners” or patients with bleeding disorders. (Aspirin or other blood thinners must be discontinued for at least 1 week prior to ESWL).

Patients with chronic kidney infection, as some fragments may not pass, so the bacteria will not be completely eliminated from the kidney.

Prior to the procedure

What to expect during you preoperative consultation

During your initial consultation we will review your medical history as well as reports and Xray films (e.g. CT scan, IVU). If your urologist determines that you are a candidate for this procedure, you will then meet with the Urology Coordinator to arrange for the date of your procedure.

NOTE: It is very important that you bring all of your X-ray films and reports of your initial consultation everytime with you for comparison and decision regarding clearance of your stone.

What to expect prior to the procedure

• ECG (electrocardiogram)
• CBC (complete blood count)
• PT / PTT (blood coagulation profile)
• Comprehensive Metabolic Panel (blood chemistry profile)

Urinalysis (Urine routine / microscopy , Urine culture/ sensitivity ( if required)

Preparation for the procedure

Medications to Avoid Prior to Surgery

Aspirin, Ibuprofen, Warfarin, Clopidogrel and some other arthritis medications can cause bleeding and should be avoided 1 week prior to the date of surgery (Please contact your urologist office if you are unsure about which medications to stop prior to ESWL. Do not stop any medication without contacting the prescribing doctor to get their approval).

It is very important that your last urine culture was negative prior to having this procedure. Please call the urologist’s office at least one week before this procedure to confirm your urine culture results. If you suspect that you may have a urinary tract infection, please inform so that proper antibiotics can be prescribed before your surgery.

The procedure

Because ESWL is a completely non-invasive therapy, most ESWL treatments are performed on an outpatient basis.The first sitting requires admission to a urology daycare for 4-6 hours.

The fluoroscope x-ray machine or ultrasound is used to focus the stone. A series of shock waves (several hundred to three thousand) is administered to the stone. Our goal when performing ESWL is to maximize the breakage of a patient’s kidney stone while minimizing injury that the shock waves can cause to the kidney and surrounding organs.

Typically, an ESWL procedure lasts for approximately thirty minutes to one hour.

 

What to expect after the procedure

Pain: Most patients experience some degree of discomfort for a day or two after ESWL. The pain lessens over the following days.

Bleeding: It is normal to see blood in the urine for 1-2 weeks after the procedure.

How do I know if ESWL was successful?

Your urologist will perform a follow-up x-ray, to determine if the stone broke up into small pieces, and if those small pieces passed out of the kidney. If the stone has broken but the fragments have not cleared, the x-rays may be repeated again following another several weeks.

If the stone has not broken up into small fragments, your urologist will likely recommend further treatment. In most cases, if the stone does not break up following 2-3 ESWL treatment, more ESWL treatments are unlikely to be successful. In this situation, other treatments, such as ureteroscopy or percutaneousnephrolithotomy, may be recommended.

WHEN TO CALL YOUR DOCTOR

Although ESWL is a safe treatment, it is important to note that adverse events, although uncommon, do occur. You should contact your doctor if any of the following occur:

Increasing pain, or pain that is getting worse instead of getting better. This may indicate either that there is bleeding around the kidney as a result of ESWL or that the kidney stone fragments have all fallen into the ureter and are blocking the drainage of urine from the kidney.

Large amounts of blood or blood clots in the urine, which may indicate that the kidney was injured by ESWL treatment.

Fever, which may indicate that there is a serious kidney infection. Fever with chills may also indicate the beginning of sepsis & may warrant the patient to get admitted for intravenous antibiotics & any ancilliary procedures if required like DJ stenting, percutaneous nephrostomy or ureterorenoscopy etc.

FAQ’S – ESWL

Q. What is lithotripsy?

A. ESWL is a treatment used in the management of kidney or ureteric stones.

Q. How does lithotripsy work?

A. The lithotripsy machine generates a shock wave using sound energy.

This energy can be focused and magnified using “acoustic lenses” which can be directed at your kidney stone, similar to how a magnifying glass can focus the suns rays to a point.

By focusing the sound energy in this manner, a shock wave can be produced at a point on the stone with enough power to shatter and fragment the stone.

Usually a large number of small shock waves are generated so that the stone can be fragmented without causing discomfort to the patient.

Q. How is the procedure carried out?

A. Your urologist will discuss with you the findings of kidney stones and may suggest lithotripsy to try and clear you of stones.

On attending the lithotripsy unit, you will be asked to changed into a gown and will be given a mild painkiller if required .

You will be asked to lie down on a large couch table and the radiographer (X-ray technician) will use an ultrasound or X-ray scanner to locate your stone on a TV monitor.

The lithotripsy treatment will then start and you will hear a number of loud regular clicks as the shock wave energy is produced. The treatment starts at a low power initially and it is gradually increased depending on how you feel.

Q. How long does the treatment take?

A. A lithotripsy session normally takes about an hour.

At the end of the treatment you may go home and we usually advise that you have an attendant with you. Some patients stay in overnight, depending on their clinical circumstances.

Q. How many treatments will I need?

A. The number of treatments depends on the size and site of the stone being treated. An X-ray will usually be taken prior to each subsequent treatment to decide how the fragmentation of the stone(s) is progressing.

Q. Can everyone have lithotripsy?

A. Patients taking warfarin should not have lithotripsy as they have an increased risk of bleeding after such treatment.

Some stones are not amenable to treatment due to their position within the kidney or urinary tract

If you have a cardiac pacemaker, you will need evaluation by your cardiologist before lithotripsy can be given. This is because the shock wave generator may interfere with the function of your pacemaker.

If you are morbidly obese (over 120 kg), lithotripsy is not advised due to low success rates and safety issues involving weight restrictions of the lithotripter. Contra indications for lithotripsy include pregnant women, patients with uncorrectable bleeding disorders and patients with a known abdominal aortic aneurysm.

Q. Are there any complications from lithotripsy?

A. When a stone is fragmented by lithotripsy, the fragments usually pass down the ureter into the bladder and then can be passed out in the urine.

If the fragments are too large, they can get stuck in the ureter and cause the symptoms of ureteric colic.

Occasionally, patients have a Double J stent inserted prior to lithotripsy to prevent any blockages like this.

Occasionally stones can harbour infection and lithotripsy can release organisms into the urinary tract causing urinary or blood infections.

If you feel unwell or develop a fever after a treatment, you should contact your urologist for urgent advice.You may need admission for i.v antibiotics & supportive therapy on an urgent basis.

Q. What follow up will I need?

A. Your progress will be monitored throughout the lithotripsy treatment to see if fragmentation and stone clearance has occurred.

X-ray pictures and ultrasound scans will help decide on your continuing management depending on if the lithotripsy is working. X- ray KUB preferrably to be done after every sitting unless told otherwise.

If a stone fragment is passed & procured, this can be sent off for analysis and will give useful information on how to advise you on dietary changes, etc. that may prevent you forming further stones in the future.

 

Check List

• Investigations
  • Renal function tests ( Urea, creatinine, Sodium, Potassium)
  • Urine routine/microscopy, Urine Culture/sensitivity
  • , PT / INR, APTT
  • Chest X-ray & ECG
• Financial Clearance
  • – TPA (Mediclaim)
  • – Cash
• Stoppage of Blood thinners
• Filling up of Admission Form
• Confirm date of admission and date of surgery
• Clarify doubts if any

I have received & read the given handouts and cleared my doubts.

 

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