It uses high-energy shock waves to break up stones. This can remove blockages and allow you to expel (urinate) stone fragments. Extracorporeal shockwave lithotripsy (ESWL) is a noninvasive procedure used by healthcare providers to treat kidney stones. It may take days or weeks after the procedure to completely eliminate the stones. Extracorporeal shock wave lithotripsy is a non-surgical treatment for kidney stones.
Extracorporeal shock wave therapy for kidney stones uses high-energy waves to break kidney stones into small fragments. At UVA Health, our urologists have extensive experience relieving pain caused by kidney stones. Lithotripsy is a non-invasive procedure (the skin is not punctured) used to treat kidney stones that are too large for pass through the urinary tracts. Lithotripsy treats kidney stones by sending concentrated ultrasonic energy or shock waves directly to the stone that was first located using a fluoroscopy (a type of X-ray “film”) or a pelvic ultrasound (high-frequency sound waves). Shock waves break down a large stone into smaller stones that will pass through the urinary system.
Lithotripsy allows people with certain types of urinary tract stones to avoid an invasive surgical procedure to remove them. To be able to direct the waves, the doctor must be able to see the stones with an X-ray or kidney ultrasound. The introduction of lithotripsy in the early 1980s revolutionized the treatment of patients with kidney stones. Patients who once needed major surgery to remove their stones could be treated with lithotripsy and not even need an incision.
Therefore, lithotripsy is the only non-invasive treatment for kidney stones, meaning that no incision or internal telescopic device is required. In the more than two decades since lithotripsy was first performed in the United States, we have learned a lot about how different patients respond to this technology. It turns out that we can identify some patients who are unlikely to achieve a successful outcome after lithotripsy, while we can predict that other patients will be more likely to have their stones removed. While many of these parameters are beyond anyone's control, such as the size of the stones and their location in the kidney, there are other maneuvers that can be performed during lithotripsy treatment that can positively influence the outcome of the procedure.
At the Brady Urological Institute, our surgeons have researched techniques to make lithotripsy safer and more effective, and we incorporate our own findings and those of other leading groups to provide truly cutting-edge treatment. When substances that are normally excreted through the kidneys remain in the urinary tract, they can crystallize and harden and turn into kidney stones. If stones break off the kidney, they can travel through and lodge in the narrowest ducts of the urinary tract. Some kidney stones are small or smooth enough to pass easily through the urinary tract without causing discomfort.
Other stones may have rough edges or grow to the size of a pea and cause extreme pain as they travel or lodge in the urinary tract. The areas most likely to catch kidney stones are the bladder, ureters, and urethra. The body takes nutrients from food and converts them into energy. Once the body has eaten the food it needs, the waste products remain in the intestine and in the blood.
The urinary system keeps chemicals, such as potassium and sodium, and water in balance, and removes a type of waste called urea from the blood. Urea is produced when protein-containing foods, such as meat, poultry, and certain vegetables, break down in the body. Urea is carried in the blood stream to the kidneys. The kidneys remove urea from the blood through small filtering units called nephrons. Each nephron is made up of a ball made up of small blood capillaries, called glomeruli, and a small tube called the renal tubule.
Urea, together with water and other waste substances, forms urine as it passes through the nephrons and travels down the renal tubules of the kidney. The main advantage of lithotripsy is that it is completely non-invasive. Lithotripsy is suitable for patients with small kidney stones that can be easily seen using X-rays. When kidney stones grow too large to pass through the urinary tract, they can cause severe pain and can also block urine flow.
Lithotripsy can be done to treat certain types of kidney stones in certain places in the urinary tract. Your doctor may recommend lithotripsy for other reasons. Patients with cardiac pacemakers should tell their doctor. Lithotripsy can be performed on patients with pacemakers with the approval of a cardiologist and taking certain precautions.
Rapid-response pacemakers that are implanted in the abdomen may be damaged during lithotripsy. There may be other risks depending on your specific medical condition. Be sure to talk to your doctor about any concerns before the procedure. Obesity and intestinal gas can interfere with a lithotripsy procedure.
Because lithotripsy is a completely non-invasive therapy, most lithotripsy treatments are performed on an outpatient basis. Although the use of anesthesia depends on patient and physician preferences, recent data suggests that lithotripsy results may improve with the administration of a mild anaesthetic. When the patient has been properly anesthetized, a computerized X-ray machine is used to determine the location of the stone within the kidney. A series of shock waves (from several hundred to two thousand) is administered to the calculation.
Our treatment protocols incorporate the findings of the most recent research, which suggests that adjustments to both the power of the shock waves and the speed at which the shock waves are transmitted may affect the outcome of the treatment. Our goal in performing lithotripsy is to maximize the rupture of the patient's kidney stone and, at the same time, minimize the injuries that shock waves can cause to the kidney and surrounding organs. A lithotripsy procedure usually takes about an hour. After surgery, you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing stabilize and you are alert, you will be taken to your hospital room or discharged. You can resume your diet and regular activities, unless your doctor advises you otherwise.
You will be advised to drink more fluids to dilute your urine and reduce the discomfort caused by evacuating stone fragments. You may notice blood in your urine for a few days or longer after the procedure. You may notice bruising on your back or abdomen. Take a pain reliever as recommended by your doctor. Aspirin or other pain medications may increase the chance of bleeding.
Be sure to take only the recommended medications. You may be given antibiotics after the procedure. Make sure you take your medication exactly as prescribed. You may be asked to filter your urine so that any remaining stones or stone fragments can be sent to the lab for testing. A follow-up visit will be scheduled a few weeks after the procedure.
If a stent was placed during the procedure, it may be removed at that time. Your doctor may give you additional or alternative instructions after the procedure, depending on your particular situation. ESWT uses ultrasound energy to treat a wide variety of conditions by spraying dense tissue or hard growths, such as kidney stones. It has many applications, such as relieving pain in people with musculoskeletal problems, such as frozen shoulder and tennis elbow.
Haseeb uses a specific application of endoscopic electrostatic therapy called lithotripsy. Shockwave lithotripsy is one way to treat kidney stones without surgery. It is also called extracorporeal shock wave lithotripsy, or ESWL. This treatment uses sound waves to break up kidney stones into tiny pieces.
These fragments can then leave the body through urine. You may be given medicine to help you relax and help ease your pain or discomfort. You can expect kidney stone fragments to be shed in the urine for several days or weeks after the procedure. In some cases, shock wave lithotripsy doesn't break down a stone enough for all the fragments to come out on their own. Shockwave lithotripsy (SWL) has proven to be a very effective treatment for eliminate kidney stones.
The SW of lithotriptors are characterized by a waveform that has an initial positive pressure component of ~20—110 MPa, followed by a negative pressure phase of ~−5—10 MPa (1 megapascal equals a pressure of ~10 atm). The procedure may work best for kidney stones in the kidney or in the part of the ureter near the kidney. Shockwave treatment works for most people who have small kidney stones in the kidney or ureter. All this means that research carried out on animals to date, while convincing that the kidney is susceptible to permanent damage, has only begun to address the clinical relevance. The ESWT is adapted to individual needs, with low or high energy sound waves depending on the size and complexity of the kidney stones.
Extracorporeal shock wave therapy (ESWT) is a non-invasive, drug-free technology that pulverizes hardened deposits of salts and minerals (kidney stones) into small fragments to facilitate their removal. Pain during a “kidney stone attack” is usually due to a stone getting stuck in the ureter and blocking the drainage of urine from the kidney. However, little is known about the threshold of damage needed to cause a lasting change, i.e., where within the kidney an acute injury is most likely to cause chronic changes, whether visible changes, such as scarring, actually represent significant harm, and about the role that pre-existing risk factors may play in progression to chronic effects. ESWL is not recommended for people with chronic kidney infection, as some fragments may not pass through and bacteria may not be completely eliminated from the kidney.