(Extracorporeal Shockwave Lithotripsy, ESWL, Shock Wave Lithotripsy)
Lithotripsy is a noninvasive (the skin is not pierced) procedure used to treat kidney stones that are too large to pass through the urinary tract. Lithotripsy treats kidney stones by sending focused ultrasonic energy or shock waves directly to the stone first located with fluoroscopy (a type of X-ray “movie”) or ultrasound (high frequency sound waves). The shock waves break a large stone into smaller stones that will pass through the urinary system. Lithotripsy allows persons with certain types of stones in the urinary system to avoid an invasive surgical procedure for stone removal. In order to aim the waves, your doctor must be able to see the stones under X-ray or ultrasound.
There are two types of shock wave technology. The original lithotripsy machines sent the shock waves through water in a tub in which the person being treated was placed. This technology remains in use today. More recently, machines have been developed that send shock waves through padded cushions on a table, so the procedure does not involve immersing a person in water.
Other procedures that may be used to treat kidney stones include:
When substances that are normally excreted through the kidneys remain in the urinary tract, they may crystallize and harden into a kidney stone. If the stones break free of the kidney, they can travel through, and get lodged in, the narrower passages of the urinary tract. Some kidney stones are small or smooth enough to pass easily through the urinary tract without discomfort. Other stones may have rough edges or grow as large as a pea causing extreme pain as they travel through or become lodged in the urinary tract. The areas most prone to trapping kidney stones are the bladder, ureters, and urethra.
Most kidney stones that develop are small enough to pass without intervention. However, in about 20 percent of cases the stone is greater than 2 centimeters (about one inch) and may require treatment. Most kidney stones are composed of calcium; however, there are other types of kidney stones that can develop. Types of kidney stones include:
The body takes nutrients from food and converts them to energy. After the body has taken the food that it needs, waste products are left behind in the bowel and in the blood.
The urinary system keeps chemicals, such as potassium and sodium, and water in balance, and removes a type of waste, called urea, from the blood. Urea is produced when foods containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the bloodstream to the kidneys.
When kidney stones become too large to pass through the urinary tract, they may cause severe pain and may also block the flow of urine. An infection may develop. Lithotripsy may be performed to treat certain types of kidney stones in certain locations within the urinary tract.
There may be other reasons for your doctor to recommend lithotripsy.
You may want to ask your doctor about the amount of radiation used during the procedure and the risks related to your particular situation. It is a good idea to keep a record of your past history of radiation exposure, such as previous scans and other types of X-rays, so that you can inform your doctor. Risks associated with radiation exposure may be related to the cumulative number of X-ray examinations and/or treatments over a long period of time.
Complications of lithotripsy may include, but are not limited to, the following:
Contraindications for lithotripsy include, but are not limited to, the following:
Patients with cardiac pacemakers should notify their doctor. Lithotripsy may be performed on patients with pacemakers with the approval of a cardiologist and using certain precautions. Rate-responsive pacemakers that are implanted in the abdomen may be damaged during lithotripsy.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.
Obesity and intestinal gas may interfere with a lithotripsy procedure.
Lithotripsy may be performed on an outpatient basis or as part of your stay in the hospital. Procedures may vary depending on your condition and your and your doctor’s practices.
Generally, lithotripsy follows this process:
After the surgery you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged home.
You may resume your usual diet and activities unless your doctor advises you differently.
You will be encouraged to drink extra fluids to dilute the urine and reduce the discomfort of passing stone fragments.
You may notice blood in your urine for a few days or longer after the procedure. This is normal.
You may notice bruising on the back or abdomen.
Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.
You may be given antibiotics after the procedure. Be sure to take the medication exactly as prescribed.
You may be asked to strain your urine so that remaining stones or stone fragments can be sent to the lab for examination.
A follow-up appointment will be scheduled within a few weeks after the procedure. If a stent was placed during the procedure, it may be removed at this time.
Notify your doctor to report any of the following:
Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.
The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your doctor. Please consult your health care provider with any questions or concerns you may have regarding your condition.
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