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Extracorporeal Shock Wave Lithotripsy (ESWL)

  • Posted on- Apr 09, 2018
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Extracorporeal Shock Wave Lithotripsy (ESWL) is the least invasive surgical stone treatment using high-frequency sound waves from an external source (outside the body) to break up kidney stones into smaller pieces and allow them to pass out through the urinary tract.

What are the main advantages of Extracorporeal Shock Wave Lithotripsy (ESWL)?

Some of the advantages of Extracorporeal Shock Wave Lithotripsy (ESWL) are:

  • Least invasive option available
  • Safe

What are the main disadvantages of Extracorporeal Shock Wave Lithotripsy (ESWL)?

Some of the main disadvantages of Extracorporeal Shock Wave Lithotripsy (ESWL) as compared to other available techniques:

  • Per treatment, it is the least successful at achieving stone clearance in one session
  • Treatment may require multiple sessions to achieve complete stone clearance
  • Results more likely influenced by patient size, stone composition, and kidney anatomy
  • Recent concerns regarding increased long-term risks of developing high blood person (hypertension) and diabetes remains an area of contention due to tissue injury to the kidney and pancreas.

What preparation is required to perform Extracorporeal Shock Wave Lithotripsy (ESWL)?

As Extracorporeal Shock Wave Lithotripsy (ESWL) is performed under sedation or general anesthesia, the patient should have nothing to eat or drink for 6 hours prior to treatment.

Regular medications can be taken with a sip of water with the exception of blood thinning agents (e.g. warfarin, aspirin, clopidogrel) or non-steroidal anti-inflammatories which need to be stopped for 7-10 days. A mid-stream urine (MSU) test is required to ensure the urine is sterile before any treatment is undertaken.

What does anyone need to bring to Extracorporeal Shock Wave Lithotripsy (ESWL) surgery?

  • All related available imaging such as KUB (kidneys, ureter, and bladder) X-ray, CT scan abdomen, or kidney ultrasound
  • The patient's usual medications

What happens in the operating room at the time of Extracorporeal Shock Wave Lithotripsy (ESWL)?

The procedure will be performed either under sedation or general anesthesia depending on the patient's situation. The patient will lie on a special operating room table containing a water-filled cushion that allows high-frequency sound waves to be transmitted to the kidney. X-rays or ultrasound are used during the procedure to precisely locate the stone and assess the effectiveness of stone fragmentation.

What are the various risks associated with Extracorporeal Shock Wave Lithotripsy (ESWL)?

Extracorporeal Shock Wave Lithotripsy (ESWL) is considered a safe procedure. Specific complications involve:

  • Pain caused by the passage of stone fragments
  • Blockage to the urine flow as a result of stone fragments causing obstruction, necessitating further surgery
  • Infection
  • Bleeding around the outside of the kidney from the shock waves bruising the tissues.

Extracorporeal Shock Wave Lithotripsy (ESWL) is not performed if the patient is:

What to expect after Extracorporeal Shock Wave Lithotripsy (ESWL)?

After Extracorporeal Shock Wave Lithotripsy (ESWL), stone fragments usually pass in the urine for up to several weeks after surgery and may result in mild pain. Occasionally, the patient will need further Extracorporeal Shock Wave Lithotripsy (ESWL) or other minimally invasive stone treatments to complete stone clearance. Strain all urine in the first 48 hours after surgery and bring the fragments to the doctor in a dry container for stone analysis.

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