ESWL

How it works?
Shock wave lithotripsy (SWL) uses high frequency sound waves from an external source (outside the body) to break a kidney stone into small pieces, and allow it to pass through the urinary tract.

Advantages:

  • Least invasive option available
  • Safe

Disadvantages:
Compared with other techniques:

  • 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 types, and unfavorable kidney anatomy
    Recent concerns regarding increased long term risk of hypertension and diabetes remains an area of contention

Pre-Operative preparations:
As ESWL is performed under sedation or general anaesthesia, you should have nothing to eat or drink for 5-6 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. Mid-stream urine test is required to ensure the urine is sterile before treatment is undertaken.

Operative method:
Procedure will be performed either under sedation or general anaesthesia depending on your situation. 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 are used during the procedure to precisely locate the stone, and assess the effectiveness of stone fragmentation.

Operative time and Hospitalization:
Pocedure is done as an OPD based . routinely admission is not required, means a day care procedure. Average procedure time is 30 to 45 minutes.

Risks:
ESWL is considered a safe procedure. Specific complications are there

  • 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.

ESWL is not performed if patient:

  • is pregnant as the sound waves and x-rays may be harmful to the developing baby
    Have a bleeding disorder
  • Have a kidney infection, urinary tract infection, or kidney cancer
  • Have kidneys with abnormal structure or function

After Procedure:
Stone fragments usually pass in the urine for up to several weeks after surgery and may result in mild pain. Occasionally, you will need further SWL 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 your doctor in a dry container for stone analysis.

Follow-up:
Patient needs to drink 8 to 10 glasses of fluid per day to aid the passage of stone fragments.
After a month. A KUB-Kidneys, Ureter, and Bladder x-ray should be done just prior to seeing the doctor.