Extracorporeal Shock Wave Lithotripsy

Extracorporeal shock wave lithotripsy (ESWL) treatment breaks your kidney stones into particles ranging in size from dust to small pieces of gravel. Most of these fragments pass out of your kidney with the normal flow of urine from the kidneys to the bladder.

A noninvasive process known as lithotripsy (short for extracorporeal shockwave lithotripsy or ESWL) breaks up stones into smaller sand-like fragments that may pass on their own. Shock waves are generated outside the body and focused on the target stone.

This technique has been in the United States since 1984 and is the most frequently used procedure to combat kidney stones. It does not require an incision. The principle for stone destruction among all types of lithotripters is the same. There are different kinds of lithotripters.

Some devices allow the patient to be placed in a water bath to allow the propagation of the shock waves; others use a soft cushion or membrane on which the patient rests for shock wave transmission.

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What can I expect from extracorporeal shockwave lithotripsy (ESWL) treatment?

  1. Prior to the procedure, patients undergo a physical examination, and their history is reviewed.
  2. Because this process can produce pain, most patients are given some type of anesthesia.
  3. Your doctor will help you decide whether you need only a sedative, regional, or general anesthesia. Most patients receive regional or general anesthesia.
  4. Lithotripsy uses x-rays or ultrasound to allow the physician to locate the stone for focusing the lithotripter.
  5. The procedure usually lasts 45 minutes to an hour.
  6. With the shock waves traveling through body tissue, side effects such as mild skin bruising in the back or abdomen may occur but usually heal in a matter of days. Blood in the urine can be another common side effect. Doctors usually advise patients to avoid taking aspirin, ibuprofen (Advil, Motrin, etc), or other drugs that affect blood clotting prior to treatment to avoid complications.
  7. ESWL is usually done on an outpatient basis, and recovery time is usually only one to two days.
  8. Patients need to know that ESWL does not remove their stone. When effective, stones are fragmented to be small enough to pass out of the kidney. Because the residual fragments can cause discomfort while they pass, the doctor may insert a stent, a narrow tube placed through the bladder and into the ureter, to assist passage.
  9. Repeat ESWL can be a possibility if initial treatment is not successful. Your doctor will evaluate your X-rays to determine if ESWL is appropriate for your stone.

Post ESWL (Extracorporeal Shock Wave Lithotripsy) Positioning

Occasionally some of these small particles settle in the lower pole (drainage area) of the kidney and do not pass into the bladder and out of your body.If these particles remain in kidney there is a chance that they will form into stones again. In order to help these particles pass we have developed the following procedure which you should follow twice a day:

  1. Drink two 8 ounce glasses of water.
  2. Wait 30 minutes.
  3. Place one end of an ironing board (or other similar board) on a chair or stool 12-18 inches from the floor. Let the other end rest on the floor so that you now have a 30-45 degree inclined plane to lie on.
  4. Lie on this board, head down, on your stomach for 30 minutes.
  5. Lie on this board, head down, with your affected kidney up for 30 minutes
  6. After getting up drink another 8 ounce glass of water.
  7. Whenever possible sleep or rest with the affected kidney up.

These steps should be followed twice a day alternating 4 and 5.

While you are laying on the board you may have-someone gently pound or vibrate the area over your kidney. This will help to loosen the stone particles. You should notice an increase in the amount of gravel in your urine after following this procedure.