Extra- Corporeal Shock Wave Lithotripsy

Shock Wave Lithotripsy (SWL) is the common treatment for kidney stones which uses sound waves of high frequency from an external source ie outside the body, targeted to break the kidney stone/s, to fragment them into smaller pieces. These small fragmented pieces can then pass through the urinary tract and outside the body.

Shock wave lithotripsy is also known as ESWL: Extracorporeal Shock Wave Lithotripsy.

  • Extracorporeal: outside the body
  • Shock waves: waves of high pressure.
  • Lithotripsy (Greek word) Litho means ‘stone’ and ‘tripsy’ means crushed.

Advantages Of ESWL:

  • Safe.
  • The least invasive.
  • High success rate.
  • Low risk of infection.
  • Non-surgical.
  • Out-patient
  • Only takes 1 hour to perform.

Symptoms:

  • Problematic urination.
  • Reduced volumes of urine.
  • Penile/ testicular aches.
  • Occurrence of blood in the urine.
  • Urgency of urination.
  • Frequent fevers.
  • Occasional chills.
  • Nausea.
  • Vomiting.
  • A fluctuating pain in the lower back, groin, or abdomen area.

Diagnosis Tests:

  • X-ray.
  • Urine Analysis.
  • Blood test.
  • Imaging tests:
  • Helical CT scans.
  • Ultrasound test for pregnant women.

Preparation:

  • General anaesthesia for sedation.
  • Avoid eating/ drinking 6 hours prior to the lithotripsy.
  • Avoid blood thinning agents like clopidogrel/ aspirin/ warfarin.
  • Continue with other regular medicines, but with minimal water intake.

Treatment:

  • A water filled/ soft cushion is placed on the patient’s abdomen behind the kidney.
  • Position the patient for an easier target at the stone.
  • Stone is detected by an ultrasound or x-rays.
  • A small thin tube is inserted via the bladder and threaded to the kidney.
  • This stent are used to avoid an infection and incase of acute pain/ blocked bladder/ hampered kidney function.
  • Shock waves with high pressure are targeted to fragment the stone/s.
  • Lot of water is given to the patient to drink.
  • Urine will be strained through a filter to separate and observe the stone fragments.
  • After an hour of observation patient is free to return home.

SWL Not Recommended For:

  • Bleeding disorder patients.
  • Pregnant ladies.
  • UTI/ kidney infections.
  • Patients with kidney cancer.
  • Abnormal functioning/structure of kidneys.

Risks:

  • The shock wave lithotripsy risks include:
  • Slight to acute pain in the urine passage.
  • Infection.
  • Bleeding around the kidneys.
  • Repetitive treatments for stone clearance.
  • Single attempt success-rate is the lowest.
  • Results are variable depending upon the stones size and type, weight of the patient and the kidney anatomy.
  • May lead to hypertension.
  • May lead to diabetes.

Prevention & Precaution is Better than Cure:

  • It’s usually recommended that someone stays with you for the first 24 hours after surgery. This is in case you experience any symptoms.
  • Timely intake of prescribed painkillers and antibiotics.
  • Alpha-blockers/ Calcium antagonists.
  • Avoid smoking/ alcohol.
  • Healthy balanced meals.
  • Switch to a low-fat/ balanced diet.
  • High intake of water.
  • Certain dietary changes:
  • Foods to avoid: oxalate-rich foods like spinach, peanuts, rhubarb, wheat germ.
  • Avoid tofu, tea, coffee, beans, berries, oranges, sweet potato.
  • Avoid fatty foods.
  • High intake of fibrous foods.
  • Adapt a healthy lifestyle and a strict diet.
  • Regular check-up and tests.

All above, treatments are finalized taking into consideration the overall health, severity, age and other ailments of the patient. Only a well experienced urologist should perform the above treatment.