Extracorporeal shockwave lithotripsy (ESWL) is a commonly used non-invasive procedure to treat renal stones. In ESWL, the surgeon will use shock waves to disintegrate kidney stones so they can be expelled efficiently from the urethra.
Are there different types of extracorporeal shockwave lithotripsy techniques?
There are several different kinds of extracorporeal shockwave lithotripsy devices. In one of the techniques, the patient is made to lie in a water bath as the shockwaves are transmitted.
Another technique requires the patient to lie down on a cushion. A majority of these devices use x-rays or ultrasound imaging to guide the surgeon during the non-invasive kidney stone treatment. Anesthesia is administered in most cases before starting the ESWL procedure.
What is shock wave lithotripsy?
Lithotripsy is the process of using high-energy shock waves to disintegrate the kidney stones. The shock wave is generated by using an electromagnetic impulse or high-voltage spark in the device outside the body and targeted on the kidney stones. This destroys the stone into tiny pieces that can be easily passed through the urine system. The term ‘extracorporeal’ is used in ESWL because the shock wave is generated outside of the body.
ESWL is useful when the kidney stone is significantly large or can get stuck in the ureter and block it eventually. If left untreated, kidney stones are known to lead to several severe and painful complications.
In ultrasonic lithotripsy, high-energy sound waves are transmitted at the kidney stone in the ureter using the electronic probe. The fragments car then be passed through the urine or surgically removed.
In electrohydraulic lithotripsy (EHL), the surgeon uses a flexible instrument to break the small stones using electric shock waves. A ureteroscope is used to position the shock wave device close to the stone in the ureter. Once fragmented, the stone pieces are removed through the urine. EHL is effective in removing stones from anywhere in the urinary system and requires general anesthesia to be performed.
How does the diagnosis determine the need for extracorporeal shock wave lithotripsy?
There are certain conditions that are considered before determining the use of ESWL on a person. A person suffering from severe skeletal defects, weighing more than 300 lb (136 kg) and person with abdominal aortic aneurysms and bleeding disorders are not considered ideal for undergoing this surgery.
Women who are pregnant also not advised ESWL. Apart from this, people with a cardiac pacemaker implant should be evaluated by an expert cardiologist before undergoing surgery.
A complete physical evaluation is done before the lithotripsy procedure. Other tests are also performed to determine the location, number and size of the stones. An IVP (intravenous Pyelogram) test is useful in locating the stones. This is done by injecting a dye in the vein in the arm. An x-ray test is then performed to determine the location of the stone in the urinary system.
In addition, blood tests are performed to see whether there is risk of bleeding. A pregnancy test will also be performed in women of childbearing age to check for pregnancy. Patients in their advanced years are advised an EKG test to rule out potential heart problems.
A stent (plastic tube) may also be placed in the ureters of some patients to allow the urine and gravel to pass normally after the ESWL is completed. A lithotripsy normally lasts for an hour. In this duration, up to 8,000 shock eaves may be transmitted on the stone. Some amount of discomfort may be there during the procedure. Painkillers may be administered to prevent this pain.
How to look after myself after an extracorporeal shock wave lithotripsy?
After a lithotripsy, the patient may pass blood along with the urine. This can last for several days to even a week. Fluid intake should be increased to help flush out any gravel (disintegrated pieces of stone) from the urinary system. Follow-up visits to a urologist are usually scheduled for about two weeks to check the success of the treatment.
Are there any risks associated with extracorporeal shock wave lithotripsy?
After an ESWL procedure, it is common to feel some amount of abdominal pain but is not a cause for concern. If the abdominal pain persists it may indicate towards an unexpected internal injury.
At times, the stone may be successfully disintegrated with the first ESWL procedure, and at other times, a repeat procedure is needed.
Some people may also be allergic to the contrast dye used in IVP, so this test is discounted for such cases. An ultrasound imaging test is advised instead.
After a successful lithotripsy procedure, the stone will be disintegrated into smaller pieces and passed through the urine, out of the body, within a few days. The patient can return to work within a few days after this procedure.
Where to get an effective extracorporeal shock wave lithotripsy performed?
It is important to select an experienced and well-trained medical expert to perform this procedure. A physician supervises or urologist will supervise this procedure as a trained technician or another individual with specialized training in urological procedures performs it.
This is an outpatient procedure and the patient is normally released the same day. There are numerous high-tech hospitals in India that offer ESWL at affordable prices. There are expert team of medical consultants and physicians who ensure that you get the best possible treatment.
Questions for the doctor:
Is the doctor certified by the relevant board in urology?
How much experienced does the doctor have for performing lithotripsy procedures? What is the complication rate of the doctor?
How to recover from extracorporeal shock wave lithotripsy?
In many cases, extracorporeal shock wave lithotripsy is done as an outpatient procedure as the recovery time is significantly short. Patients are able to resume normal everyday activities within a few days following the procedure.