extracorporeal shock wave lithotripsy (ESWL)

What is involved in the extracorporeal shock wave lithotripsy (ESWL) procedure?

Extracorporeal Shock Wave Lithotripsy, commonly abbreviated as ESWL, stands as a revolutionary non-invasive technique designed to address kidney stones. This medical procedure utilizes shock waves generated externally and focused precisely on the targeted kidney stone. Through the skin, these shock waves break down the stones into smaller, more manageable fragments, facilitating their natural passage through the urinary tract. ESWL eliminates the need for surgical intervention, providing a safer and more comfortable alternative for patients dealing with kidney stones.

ESWL main points

Key Points:

ESWL offers a low-risk, non-invasive approach to treat kidney or ureter stones.

• Focused shockwaves pass through the skin to target stones, guided by X-ray or ultrasound.

• Certain stones may remain resistant to fragmentation even after re-treatment due to their hardness.

• Common after-effects of lithotripsy include bleeding and temporary pain as the stone fragments pass through the urinary tract.

  Understanding the contraindications for shockwave lithotripsy is crucial

• Shockwave lithotripsy in contraindicated in pregnant women.

• Contraindicated for those on anticoagulant medications (blood thinners).

• Not suitable for patients with cardiac pacemakers.

• Should be deferred in the cases of urinary infections.

• Contraindicated for individuals with untreated high blood pressure.

• Inadvisable for those with an aortic aneurysm.

surgery

What occurs on the day of the procedure?

A/Prof Homi Zargar will discuss the surgery once again to ensure your understanding and obtain your consent. An anaesthetist will meet with you to explore the options of a general or spinal anaesthetic and discuss post-procedure pain relief.

Details of the procedure:

• Depending on individual circumstances, the procedure is typically conducted under either general anaesthesia or with sedation.

• Before the procedure, antibiotics are administered after confirming the absence of allergies.

• On the treatment couch, gel or water is applied for good contact.

• Shockwaves are fired by the machine after pinpointing the stone.

• Additional painkiller or sedation can be provided if necessary.

• Pauses occur to check stone position and adjust targeting.

• Treatment duration varies (30 to 60 minutes) based on stone size.

• Discharge within a couple of hours, but avoid driving home.

After-Effects and Risks of the Procedure:

• Blood in your urine, potentially lasting several days, occurs between 1 in 2 and 1 in 10 patients.

• Kidney pain may be experienced as small stone fragments pass, with a likelihood between 1 in 2 and 1 in 10 patients.

• The need for additional lithotripsy to clear remaining stones is present in between 1 in 2 and 1 in 10 patients.

• In cases of failure to break the stone, requiring an alternative treatment, the likelihood is between 1 in 2 and 1 in 10 patients.

• Recurrence of stones in the future is a possibility, affecting between 1 in 2 and 1 in 10 patients.

• Infection on your urinary tract may occur, with a likelihood between 1 in 10 and 1 in 50 patients.

• Bruising or blistering of the skin at the shockwave entry or exit site can happen, affecting between 1 in 10 and 1 in 50 patients.

• Fragments getting stuck in your ureter (between the kidney and bladder), requiring surgical removal, may occur in between 1 in 10 and 1 in 50 patients.

• Severe infection, necessitating injected antibiotics or kidney drainage with a small tube (nephrostomy), occurs between 1 in 50 and 1 in 250 patients.

• Kidney damage with severe bruising may happen, affecting between 1 in 50 and 1 in 250 patients.

• Inadvertent damage to the pancreas or lungs is a rare occurrence, with a likelihood between 1 in 50 and 1 in 250 patients.