ESWL

Kidney stones occur when you have less fluid in your urine than the minerals. Depending on the type and size of your kidney stones, the endourologist recommends different treatments, which can also include surgery. Extracorporeal shock wave lithotripsy or ESWL is one of the surgical methods used when the kidney stone blocks the urinary tract or has a bigger size.

Extracorporeal shock wave lithotripsy (ESWL) is a very common non-surgical approach for treating stones in the kidney and ureter. In this technique, high-energy shock waves or sound waves are transmitted through the body to break the stones into small-sized fragments so that they can easily pass through the urinary tract.

1. It is a non-invasive technique and leaves no scar 
2. Fragment the stones of size 1.5 to 2 cm into sand-like particles so that they pass out easily.
3. It is an outpatient procedure that does not require anesthesia or admission.
4. Fast recovery.

ESWL is recommended in the following cases:

1. Kidney or ureter stones are larger than 5 mm in diameter and cannot pass out on their own
2. For stones that are blocking the ureter or the flow of urine and are very painful.
3. You have a large kidney stone.
4. You are at higher risk for infection.
5. Your kidney functioning is reduced.

 

You will be lying down on the operating table. A water-filled cushion will be placed behind your back or on your abdomen. Before carrying out ESWL, your surgeon may insert a tube called a stent through your urinary bladder and up to the kidney. 

While performing ESWL, your surgeon will:

1. Use X-rays or ultrasound to locate your kidney stone
2. Use shock wave lithotripsy equipment to transmit intense energy waves into your body through the water. Thousands of shock waves will be directed at your kidney stone, breaking it into several fragments. These smaller fragments can now move through the urinary tract more easily.
3. It will take close to 45 to 60 minutes to complete the procedure.

During your pre-surgical appointment, inform your operating endourologist if you:

1. Are currently using any prescription, non-prescription, supplements, or blood-thinning medications (e.g., aspirin and ibuprofen)
2. Have any allergies to medicines or foods

What to Expect Before Surgery?

Your operating surgeon may schedule a pre-operative testing one month before the date of your treatment. During the appointment, your surgeon will recommend you:

Several tests are listed below, depending on your age, medical history, medications, and overall state of health:

1. Blood test 
2. Electrocardiogram (ECG)
3. Urine culture
4. Urine analysis
5. Blood chemistry profile
6. Blood coagulation profile (PT/PTT)
7. Stop taking blood-thinning medications at least seven to 10 days before the procedure, as these drugs can increase your risk of bleeding.
8. Arrange for someone (a friend or family member) to drive you home after the procedure.
9. To undergo ESWL, your anaesthesiologist will recommend local or general anaesthesia.

What to Expect During the Surgery?

You can expect the following while undergoing ESWL:

1. If given general anaesthesia, you will be unconscious during the whole procedure.
2. However, if you have been given local anaesthesia, you will be awake during the procedure and might hear a loud popping sound as the lithotripsy machine starts the shock waves.

 

At hospital:

1. ESWL is generally performed on an outpatient basis. You might have to spend a few hours in the recovery room, but you should be able to go home the same day.
2. You can get up and walk almost immediately after the procedure.

At home:

1. Stone fragments commonly flow in the urine for a few days after ESWL and cause little pain. You can take over-the-counter pain relievers until you have passed all the stone fragments.
2. You can also expect to find some blood in your urine in the days following the procedure. This is normal.
3. You will be able to return to your normal routine in one to two days.
4. No special diet is required after the surgery; however, you should drink a lot of water to aid in the passage of the stone fragments.
5. You will most likely be asked to strain your urine at home to check for stones. Your endourologist will explain this process to you. Then, you can send any stones you find to a medical laboratory for analysis.
6. You will receive painkillers and antibiotics to relieve post-surgical pain and prevent infection, respectively.

First Follow-up Appointment

You will have follow-up visits with your endourologist for the first few weeks after the procedure for routine monitoring.

 

You may experience side effects after undergoing ESWL like:

1. Soreness or stiffness near the surgical site
2. Pinkish-coloured urine (due to small amount of blood)
3. Stone fragments in your urine (use a urine strainer provided by your surgeon to collect these fragments)
4. Potential risks and complications of ESWL include:
5. Blockage in your ureters
6. Bleeding around your kidney
7. Blood or pain while passing urine
8. Bruising or discomfort at the surgical site
9. Infection

Call your endourologist immediately if you notice any of the following symptoms after ESWL:

1. Severe pain in the back that does not go away even after taking medications
2. Palpitations (rapid heartbeat)
3. Fever more than 101 degree F
4. Presence of large blood clots in urine
5. Urine with a foul odour
6. Chills
7. Burning sensation during urinating
8. Minimal urine output.