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X-Plain Lithotripsy - ESWL

Reference Summary

Introduction Kidney stones are fairly common. Although kidney stones can be very painful, they are treatable, and in many cases preventable.

Your doctor may recommend Extracorporeal Shock Wave Lithotripsy, or ESWL, to treat your kidney stones. The decision to have this procedure is yours.

This reference summary will help you understand the treatment options for kidney stones, specifically Extracorporeal Shock Wave Lithotripsy, or ESWL. It discusses the causes and symptoms of kidney stones and their treatment options. The benefits and risks of ESWL are also presented, followed by what to expect after the procedure.

Anatomy Most people are born with two kidneys. Kidneys are bean-shaped organs on both sides of the spine. Kidney

This document for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition. ©1995-2010 The Patient Education Institute, Inc. www.X-Plain.com ur080103 Last reviewed: 11/21/2009

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Ureter

Bladder

The main function of the kidneys is to regulate the amount of water in the body and to remove harmful chemicals known as toxins from your blood. The kidneys secrete these toxins into urine.

Urine flows through tubes called ureters to the bladder, where it is stored. When the bladder is full, people feel the urge to urinate. The urine is emptied through the urethra.

Kidney Stones A person’s urine can be high in minerals. If these minerals become too concentrated, they can form crystals, which may then combine and form small, hard stones in your kidney. These stones vary in size from a few millimeters to a few inches.

When these stones become dislodged from the kidney, they travel down the ureters to the bladder. Kidney

Stone

Most people are able to pass these stones without a problem. Some people, however, experience severe pain when the stones travel through the ureters.

This pain is usually located in the back, flank, or groin area, and can last from five to fifteen minutes at a time. This pain is known as “renal colic”.

Kidney stones can also get stuck in the ureters. If this occurs, the pain can persist for days and the urine flow from the kidney to the bladder might be blocked. This can lead to urine back pressure on the kidney, which may result in the loss of the kidney. Therefore, it is important to remove these stones.

Pain is often the most noticeable symptom of kidney stones. Other symptoms that indicate kidney stones include:

• nausea, • vomiting, • bloody or foul-smelling urine, • and the constant urge to urinate.

Treatment Options Depending on the patient’s symptoms, as well as the size and location of the stone, the urologist, a physician specialized in kidney and bladder diseases, may just wait and see if the patient can pass the stone on his or her own.


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Patients are usually given medication to help with the severe pain. Patients are asked to drink a lot of fluid, approximately 12 eight-ounce glasses a day, to help ‘flush out’ the kidney. This is known as “expectant therapy.”


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If the symptoms are not very severe, medication can be given in some cases to change the composition of the urine and help dissolve the stone. This takes a long time and is not a good option in cases of severe pain or urinary obstruction.

If pain persists and the patient has not been able to pass the stone, further treatment may be tried. The urologist may decide to go to the site of the stone using a scope placed through the urethra and bladder into the ureter. There the stone can be ‘fished’ out using special baskets, or broken down with a laser or other mechanical devices. This procedure is known as Ureteroscopic Stone Removal.

Sometimes the urologist can only reach the stone by making an incision in the back and placing the scope into the kidney and down the ureter. This surgical procedure is known as Percutaneous Stone Removal.

The least invasive way to deal with these stones remains ESWL, or Extracorporeal Shock Wave Lithotripsy, which is discussed next.

The doctor considers the size, number, location and composition of the stones when recommending a treatment option. The patient’s size and medical condition are other factors to consider when exploring treatment options.

ESWL During ESWL, the urologist breaks down the stone with shock waves. No incisions are done and usually no instruments are inserted into the body. A urologist is a physician specialized in kidney and bladder diseases. The waves, also called sound waves, turn the stone to “sand,” which is then passed out of the body easily with urine. In some cases, where the stone is large, the urologist may insert a stent before the ESWL to help the fragmented stone pass without discomfort.

About one to two thousand shock waves are needed to crush the stone. The entire treatment takes about 45 to 60 minutes. ESWL is usually an outpatient procedure, which means the patient goes home the same day of the procedure. There are two methods of shock wave treatment. In one method, the patient is placed in a tub of lukewarm water. In the second, more common method, the patient lies on a soft cushion or membrane through which the waves pass.

ESWL is usually done under general anesthesia. General anesthesia puts the patient to sleep so he or she does not feel any pain.

The urologist will first locate the stone using X-rays or ultrasounds. The urologist then targets shock waves at the stone through the body using a special machine. This causes the stone to crumble and become smaller. These smaller pieces should pass easier. The machine used to generate the shock waves makes a loud noise. The patient is given protective headphones to wear during the procedure to protect the eardrums.

Risks and Complications ESWL is a very safe and effective operation. Risks and complications are exceedingly rare.

If general anesthesia is used, its risks include nausea, vomiting, urinary retention, cut lips, chipped teeth, sore throat, and headache. More serious risks of general anesthesia include heart attack, stroke, and pneumonia. Your anesthesiologist will discuss these risks with you and ask you if you are allergic to certain medications.

Blood clots in the legs can occur due to inactivity during and after the procedure. These usually show up a few days after the procedure. They cause the leg to swell and hurt.

Blood clots can become dislodged from the leg and go to the lungs, where they will cause shortness of breath, chest pain and possibly death. It is extremely important to let your doctors know if any of these symptoms occur. Sometimes the shortness of breath can happen without warning. Getting out of bed shortly after the procedure may help decrease the risk of blood clots in the legs.


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Most patients have some blood in the urine for a few days. The broken stone pieces may cause discomfort as they pass through urine.

Sometimes, the stone is not completely shattered, and the ESWL procedure may need to be repeated. Some stones are found to be very tough and resistant to ESWL. This may lead the urologist to suggest other methods to remove the stone.

After the Procedure After the procedure, you will stay in the recovery room for up to 2 hours. ESWL is usually an outpatient procedure, which means the patient goes home the same day.

Since you will have anesthesia, it is important that someone drive you home.

After treatment is complete, you can move about almost at once. Most people can fully resume daily activities one to two days after ESWL.

The urologist will suggest that you drink plenty of water in the weeks following the procedure. This will increase the rate of urination, which helps the remaining pieces of stone pass from the body.

Most patients have a small amount of blood in their urine after the procedure. This is normal and can last as little as a few days and as long as a few weeks. Some pain may occur when the fragments pass, which begins soon after treatment and may last for up to four to eight weeks. Oral pain medication and drinking lots of water will help relieve symptoms.

It is important that you strain your urine following the procedure (urinate through a mesh material that will collect any non-liquid substance). This will help confirm that the remaining pieces of stone have passed. You should give these pieces to your doctor. They can help him or her determine the exact make-up of the stone.


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Knowing what the stone is made of will help you and your doctor understand what caused the stones and how to prevent stones from developing in the future.

After determining what the stone’s make-up is, the urologist may suggest: • drinking a lot of water, in some cases as many as 14 cups a day, • participating in physical activity, such as walking, and • lowering the salt and animal protein content of your diet.

The urologist may also prescribe medications. The type of medication the urologist prescribes depends on the kind of stone passed, so it is important that you retain a sample of the stone and give it to the doctor.

Summary Kidney stones can be very painful. Fortunately, they are treatable and preventable. If the stone is not passed spontaneously and after taking medications, your doctor may recommend ESWL.

ESWL is the least invasive procedure to remove kidney stones. It is also a very safe and effective way to get rid of painful stones.

During ESWL, the doctor breaks down the stone with shock waves. No incisions are done and no instruments are inserted into the body. The waves, also called sound waves, turn the stone to “sand,” which is then passed out of the body easily with urine.

Like any procedure, ESWL has risks. Though these risks are rare, knowing about them may help you find them and treat them earlier.


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