Extracorporeal shock wave lithotripsy (ESWL) or “kidney shock wave” procedure is used to treat kidney stones.
Key points
- Non-invasive treatment
- Uses Ultrasound Wave Technology
- Outpatient procedure
- Sessions last approximately 45 minutes
- Effective for patients with small to mid-sized stones.
Why choose Urocare?
At Urocare London, our commitment to excellence in urology is driven by the expertise and dedication of our leading specialist, Mr. Maneesh Ghei. Located at leading private hospitals in London, Urocare London offers the convenience and accessibility you need.
What is ESWL?
Extracorporeal Shock Wave Lithotripsy (ESWL) is a modern medical procedure designed to treat kidney stones and some ureteric stones using focused ultrasonic energy.
This technique allows for the breaking of stones into sand-like particles without the need for surgical incisions. By targeting stones from outside the body, ESWL minimises the physical impact on patients, providing a safer and quicker recovery compared to more invasive procedures.
Who is ESWL suitable for?
ESWL is most effective for individuals with kidney stones smaller than 2 cm in diameter and located in the kidney or upper part of the ureter. The treatment is especially suitable for patients who prefer a noninvasive option or those for whom surgical interventions pose greater risks, such as individuals with bleeding disorders or those who are morbidly obese. It’s also well-suited for patients looking for a procedure with minimal downtime.
Is ESWL a major operation?
ESWL is not considered a major operation. It is a non-invasive, outpatient procedure that involves no incisions or stitches. The process is performed using external shock waves, making it a preferred choice for many patients due to its reduced risks and lack of surgical recovery.
How does ESWL work?
- Patient Positioning: The patient is comfortably positioned on a specialised table that allows optimal access to the target area using imaging guidance.
- Pain Management: Prior to starting the procedure, patients are given pain medication to help manage discomfort during the treatment. This could be in the form of injections or oral tablets.
- Imaging Guidance: The stone is located using real-time imaging techniques such as X-ray or ultrasound, which help in precisely targeting the shock waves.
- Shock Wave Application: A machine called a lithotripter generates shock waves that are directed at the stone. These high-energy waves travel through the body and focus on the stone, breaking it into small pieces.
- Stone Fragmentation: The shock waves break the stone into fragments small enough to be passed naturally through the urinary tract.
How long does an ESWL operation last?
The duration of each ESWL session is about 45 minutes. The total number of sessions required can vary depending on the stone’s size, density, and number of stones present. Some patients might need only one session, while others may require several to effectively clear all stone material.
What to expect after Extracorporeal Shock Wave Lithotripsy
Post-ESWL, patients generally experience some minor side effects as the body expels the stone fragments. These can include:
- Hematuria: Blood in the urine is common and typically resolves within a few days.
- Abdominal Discomfort: Pain or discomfort near the treated kidney or along the urinary tract as stone fragments pass.
- Urinary Symptoms: Urgency, frequency, or discomfort during urination as the fragments make their way out of the body.
Side effects of ESWL
While ESWL is safe and effective, some patients may experience side effects such as:
- Persistent Blood in Urine: While usually temporary, persistent cases may require further medical attention.
- Bruising: Bruising around the treated area due to the shock waves.
- Stone Fragment Stuck: Occasionally, larger fragments can get lodged in the ureter, requiring additional interventions.
Alternative treatments to ESWL
If ESWL is not effective or suitable, alternatives include:
- Ureteroscopy: A minimally invasive procedure where a small scope is inserted into the ureter to locate and remove or break up stones directly.
- Percutaneous Nephrolithotomy: A surgical procedure for larger or more stubborn stones, involving a small incision in the back to directly remove the stones.
Frequently asked questions
Is ESWL painful?
Patients may experience mild to moderate discomfort during ESWL, although pain levels can vary. Pain management protocols, such as painkillers administered before the procedure, help minimise any discomfort. Most patients report the sensation as manageable.
How quickly can I return to normal activities?
Most patients can return to their normal activities within one to two days after the procedure. However, it’s advisable to avoid strenuous activities for at least one week to allow the body to heal and to promote the passing of stone fragments.
Can ESWL be repeated?
Yes, if the stones are not completely broken up during the initial session, ESWL can be repeated. The number of sessions required can depend on the stone’s size, location, and how well it responds to the treatment.
What are the success rates of ESWL?
The success rate of ESWL can vary widely, typically ranging from 70% to 90%, depending on factors such as the stone size, density, and location. Stones in the kidney are generally broken more easily than those in the ureter.
Will I need any follow-up after the procedure?
Yes, follow-up appointments are important to monitor the patient’s progress, ensure all stone fragments have passed, and check for any possible complications. Imaging tests may be conducted during follow-up visits to assess the status of any remaining stones.
What should I eat after undergoing ESWL?
Drinking plenty of water is recommended to help pass the stone fragments more easily. Avoiding excessive salt and protein intake can also be beneficial, as these can contribute to stone formation.
Are there any factors that could make me ineligible for ESWL?
Certain factors can affect your eligibility for ESWL, including pregnancy, having a bleeding disorder, severe obesity, or the presence of certain types of hard, cystine stones that do not respond well to shock wave treatment.
How effective is ESWL compared to other kidney stone treatments?
ESWL is less invasive than surgical options like ureteroscopy and percutaneous nephrolithotomy, which generally makes it a safer choice with a quicker recovery. However, it may be less effective for very large or hard stones, for which other treatments might be recommended.
