Kidney stones form when waste materials in the body form crystals and become trapped within narrow passageways in the kidney, causing extreme discomfort and stopping urine flow.
Lithotripsy uses shock waves to break up and dislodge stones from your urinary tract without resorting to surgery, but can have potentially severe side effects. While highly effective, there may also be adverse reactions which should be considered before proceeding with such therapy.
What is lithotripsy?
Many kidney stones are too small to cause pain and will pass naturally, however larger stones may get stuck in your urinary tract and require lithotripsy as a method of breaking them up into manageable pieces so they can pass out of your system via urine. If lithotripsy fails, high-energy shock waves may be used instead to break apart large kidney stones into fragments so they can pass easily out through urine.
Before your procedure begins, you will receive anesthesia to keep you asleep or drowsy during it. This may involve general anesthesia or regional anesthetics like spinal anesthesia. Once under, you will lie on a padded table atop a water-filled cushion or in a tub; your care team will use X-rays and ultrasound imaging technology to locate your kidney stone while helping position yourself for maximum effectiveness; additionally X-rays will be used to screen for infection or other problems with your kidney or urinary tract.
ESWL providers use a device known as a lithotripter to administer shockwave treatments into your body. This device features a special focus zone designed for treating kidney stones; depending on their size and the type of lithotripter used, multiple sessions may be needed for full treatment.
The lithotripter uses focused energy fields around kidney stones to prevent further damage to other organs and tissue, and to increase ESWL effectiveness by enabling multiple stones to be targeted simultaneously. It’s designed to be as safe and effective as possible for you!
Before receiving lithotripsy treatments, you will sign a consent form and answer questions about your health from your provider. Blood or urine tests might be administered and fasting for several hours is often required prior to this procedure. Be sure to inform them if you have any heart conditions or are pregnant as the procedure could potentially harm both mother and fetus if administered during gestation. Also stop taking certain medicines such as warfarin prior to having this procedure done.
How is ESWL done?
Extracorporeal shock wave lithotripsy, or ESWL, utilizes sound waves to break kidney stones into small fragments that will then pass out of your system via urine. The noninvasive procedure does not require anesthesia and usually lasts 30- 40 minutes; you’ll lie on a treatment table while we place a cushion over your abdomen to protect from shock waves generated by our lithotripsy machine; additionally we’ll use computer software to help pinpoint its location.
ESWL can be used to treat virtually every kind of kidney stone safely for most people, although you may require painkillers or sleep aid prior to beginning.
The lithotripsy machine uses shock waves of high energy to deliver heat directly to a kidney stone, heating its surrounding tissues while simultaneously cracking it into smaller pieces – making it easier for it to be excreted from your body through urine. There are two different kinds of shock waves produced by lithotripsy – electrohydraulic (which acts like underwater fireworks), and electromagnetic (which uses electricity running through coils in the machine).
There are various kinds of lithotripsy machines, each offering its own distinct set of benefits in terms of how it delivers shock waves and the size and concentration of their focal zone (where shockwaves condense). Their capacity for breaking apart stones also can differ.
Kidney stones are rock-like deposits that form inside your kidneys or ureters (the tubes that carry urine from your kidneys to your bladder), often too large for natural passage through your system. ESWL provides an efficient, noninvasive means to break these large stones up into manageable fragments for passage out of your body.
Once we have completed the ESWL process, we will examine your X-ray to ensure all stone fragments have passed through your urinary tract. If any remain behind, your surgeon may suggest another approach such as ureteroscopy. Kidney stones that cannot pass spontaneously may also be broken apart using percutaneous nephrolithotomy surgery.
What is the recovery period like?
Kidney stones form when substances excreted by the kidneys, such as calcium or uric acid, crystallize into large chunks that become too big to pass through the narrower passages of the urinary tract. Pieces may break off and travel down through ureters and urethra or become trapped inside kidney itself; some pieces are smooth enough to pass without discomfort; while others have sharp edges that cause extreme discomfort as they pass.
Kidney stone lithotripsy is an outpatient process. Your urologist will use either X-rays or ultrasound imaging to pinpoint your stones, before positioning you on a table and sending shockwaves through your body that target these specific stones for 45-60 minutes – though depending on the size and composition of your kidney stones, multiple treatment sessions may be required.
As you recover, you may experience discomfort when urinating, which is normal and should dissipate within several days. You may also detect blood in your urine – this too should resolve over time. Throughout this process, make sure to drink lots of water and take any prescribed or over-the-counter painkillers as directed.
After several weeks have passed since your initial lithotripsy visit, you will return for a follow-up visit with your urologist to check for any remaining stone fragments and to consider alternative treatment options, such as ureteroscopy or percutaneous nephrolithotomy surgery if your ureters were compromised during lithotripsy treatment.
Some patients’ residual stone fragments are too large for lithotripsy alone to break up; in these instances, a stent – an elastic tube that takes urine from kidney to bladder – may be placed within their ureter in order to facilitate healing while helping pass more easily through ureter and bladder. This allows more efficient passageway for stones into bladder.
If you have a stent implanted, your healthcare team may advise straining every time you urinate to collect any stone fragments that come out with your pee. Doing this allows the urologist to study them properly.
What are the risks of ESWL?
Extracorporeal shock wave lithotripsy (ESWL) has become the go-to option for treating larger kidney stones since its introduction in the 1980s, often replacing surgery as the go-to treatment option. ESWL uses sound waves to break apart large kidney stones into smaller fragments. It quickly gained acceptance as the best approach. ESWL is a noninvasive procedure that doesn’t require anesthesia and typically performed outpatient in hospitals and clinics. Your care team will use X-rays or ultrasound to locate the stone before guiding a machine (lithotripter) over its location to produce high-energy shock waves that will travel through your body to hit it and break it into fragments – this process typically lasts an hour.
Your care team may need to repeat ESWL if your kidney stone does not break up into small fragments after its first session of ESWL treatment, as not all stones respond well to ESWL and stones with high calcium or hardness content can be difficult to treat with this method.
When receiving an ESWL procedure, you’ll lie on a padded table and may either be asleep or awake but drowsy depending on your health condition and type of anesthesia your physician prescribes. Your care team may move slightly so as to align shock waves with the stone.
When successfully treated, symptoms typically resolve soon after an ESWL procedure; however, if kidney stones remain unaddressed after this approach they could continue causing discomfort for several days following. Your care team will monitor you carefully for complications and may suggest alternative solutions as necessary.
Some patients need additional procedures to remove remaining kidney stone fragments, including endoscopic retrograde cholecystography (ERCP). ERCP involves inserting a flexible tube with a camera into your intestines in order to view and remove stones; an endoscopic submucosalWLateral (ESWL) procedure may also be done prior to ERCP in order to protect pancreatic duct injury.
Although ESWL has a low complication rate, the damage caused by shock waves can be serious. They can lead to kidney rupture or psoas abscess (a painful lump in the lower abdomen). Unfortunately, such injuries cannot always be avoided and could potentially lead to long-term issues like diabetes.
