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Extracorporeal Shock wave Lithotripsy (ESWL) is an efficient non-invasive kidney stone treatment available at the most economical cost in India. No cuts/incision. Quick recovery. Early resumption of daily activities.
Kidney stone treatment constitutes the major workload of any urology center.
ESWL is the only non-surgical treatment for kidney or ureter stones. Other treatment options for kidney or ureter stones are Minimally invasive endourological techniques such as PCNL (Percutaneous Nephrolithotomy) and URS (Ureterorenoscopy).
Combined together, both non-invasive and minimally invasive procedures have dramatically reduced the necessity of open surgery as the treatment for kidney stones.
Extracorporeal implies treatment given from "outside the body."
Shock waves or high-pressure waves are concentrated on the kidney stone/s from outside the body in order to break them into tiny fragments that can easily pass through ureters.
"Litho" stands for stone and "Tripsy" implies "breaking down into fragments." These tiny stone fragments are eventually passed through urine on their own.
As a general rule, ESWL (Shock Wave Lithotripsy) is recommended as a primary treatment option in patients with normal kidney structure, simple stone problem, and stone size of less than or equal to 2.5 cm at the most.
Q1 When is shock wave lithotripsy recommended for the treatment of kidney stones?
A1 ESWL is generally reserved for kidney or ureter stones of size less than 2.5 cms. It is not a viable treatment for treating large stones.
Stone size is just one of the factors for determining the viability of ESWL (Shock Wave Lithotripsy) as kidney stone treatment. Other factors such as general health of the patient, structural and functional health of the kidney, location of the stone and type of the stone are also taken into consideration. The final call is taken by your specialist in choosing the best treatment plan for you.
Q2 Under what conditions, ESWL is not a suitable treatment for kidney stone patients?
A 2 Shock wave lithotripsy is not a viable treatment modality for a kidney stone patient if,
Kidney stone is very large
Morbidly Obese patient as the distance between skin and the stone is increased
Presence of any other Kidney problem as well
Pregnant patient since this treatment involves the use of shock waves and X rays
Patient with a cardiac pacemaker
Patient with bleeding disorders, infection, or a severe skeletal disorder.
Obstruction of the urinary tract distal (lower down in the urinary tract beyond the stone location)to the stone location.
Presence of active urinary tract infection
Q3 Does the presence of a kidney stone need immediate treatment?
A3. It depends.
A small kidney stone may pass through urine on its own and therefore, may not require any treatment at all. However, those kidney or ureter stones that do not pass through urine, call for treatment of some sort.
The urgency with which kidney stone treatment is sought is determined by the presence and frequency of annoying symptoms, if both kidneys have stones, if the kidney's functionality or health is being adversely affected if the patient has had a kidney transplant done or has only one kidney.
Under all the above conditions, the patient will need immediate treatment.
Q4 What preparation is required in the case of a Shock wave lithotripsy procedure for a kidney stone patient?
A4 Before ESWL procedure is performed, a basic evaluation is done which may include certain blood tests such as Complete Hemogram, screening for coagulation abnormalities, blood urea and Serum Creatinine, Urinalysis, Urine culture, ECG and IV Urogram.
An additional procedure, Double J Stenting, may be required in some patients before the ESWL procedure. Such as patients with stones in the single functioning kidney, impacted stone in the upper ureter and a kidney stone exceeding a certain size. It is purely at the discretion of your treating specialist to decide how to go about the treatment in your case.
Q5 What happens in Shock Wave Lithotripsy Procedure?
A5 After a Pre-anesthetic check-up is done and the specialist thinks it is absolutely fine to go ahead with the ESWL procedure, the patient is admitted to the hospital on the day of the procedure. Though, the procedure may be done as an outpatient procedure.
Anesthesia is given as required. Some pain killers and an antibiotic are started prior to the procedure. Vital parameters of the patient are closely and continuously monitored.
Routine stone localization is done with the help of fluoroscopy and ultrasonic localization in certain cases, followed by shock wave delivery. Stone fragmentation is monitored periodically with the help of fluoroscopy.
The patient is usually discharged after 24 hours of observation, provided there are no symptoms and vitals are stable
Q6 How much time does ESWL procedure take?
A6 Nearly 1 hour. However, the duration of the shock wave lithotripsy procedure may vary from case to case.
Q7 What kind of anesthesia is required during the Shock Wave Lithotripsy procedure to remove kidney stones?
A7. Though it is not a surgery, it still is associated with some pain. To take care of that, your specialist may opt for light sedation and local or General Anesthesia for you.
It is purely at the discretion of your urologist who takes the following factors into consideration before zeroing on the type of anesthesia best suited for you.
Type of the technique, type of the kidney stone, and of course, the patient.
The anesthesia ensures that the patient remains still during the procedure and the procedure can be done efficiently without any discomfort to the patient and better results as these are the objectives to be met.
Q8 What can a patient expect after the Shock wave lithotripsy procedure?
A8. Short recovery period. Short or no hospital stay. Resumption of daily activities within a day or two. The patient can walk almost immediately after the procedure. Needs to drink plenty of fluids in order to get rid of those stone fragments through urine. Plenty of fluids will help them pass easily through urine.
The patient may pass stone fragments for a few days or weeks.
Q9 Will ESWL get my stone out completely in a single session?
A 9 You may require one or more sessions of Shock Wave Lithotripsy, ESWL procedure to remove kidney stones entirely.
Q10 Does a Shock wave lithotripsy procedure for treating kidney stones require a hospital stay?
A10 Not really. It is usually done on an outpatient basis. However, the need for hospitalization varies from case to case. Your specialist will be the best person to decide whether you will need hospitalization or not for this procedure.
Q11 Are there any risks associated with the Lithotripsy procedure done as kidney stone treatment?
A11. The selection of the right candidate for shock wave lithotripsy procedure is very crucial as it will decide the outcome for the patient and the specialist as well.
The success rate of SWL is highly dependent on the right selection of the kidney stone patient for the Shock wave Lithotripsy procedure.
The effectiveness of SWL is determined by the stone burden. This procedure also has its own share of limitations.
Shock wave lithotripsy is also associated with certain risks such as acute kidney or other tissue/organ injury, it does have the potential to have long term adverse effects, bleeding.
Some individuals particularly elderly patients and those who have been through multiple SWL procedures, may develop new onset High blood pressure or Diabetes mellitus.
Though, urologists have overcome its shortcomings by delivering shock waves at a slower rate and in a step wise pattern. They have achieved the objective of fragmenting the stone with fewer shock waves that too at a lowest power level possible.
Q12 What are the advantages and disadvantages of the Shock wave lithotripsy procedure?
A12 Shock wave lithotripsy is a non-invasive procedure to treat certain kinds of kidney stones in contrast to minimally invasive procedures such as PCNL (Percutaneous Nephrolithotomy) and URS (Ureterorenoscopy), which are other treatment options for kidney stones.
Shock wave lithotripsy has lots of advantages to offer such as
High acceptance by the patients
Low rate of complications
It is technically easy to perform.
No Incision, therefore reduced or no hospital stay
Early resumption of daily activities
At present, ESWL and other minimally invasive endourological techniques to treat kidney stones have remarkably reduced the need for open surgery.
Disadvantages may include the following:
Multiple sessions may be required to remove the urinary tract stone entirely.
ESWL may turn out to be inadequate and therefore, may call for additional treatment modality eventually, to treat the urinary tract stone.
Shock wave lithotripsy is a cause of High blood pressure and Diabetes in the long run. This is still under speculation.
ESWL may cause kidney injury or another tissue injury.
Challenges associated with ESWL that still need to overcome are minimizing the occurance of residual stone fragments, better targeting the stone, to determine when the stone fragmentation is finished and betterment of shock waves transmission across barriers such as air pockets. These factors largely determine the efficacy of SWL.
Not beneficial in case of complex kidney structure such as Lower pole calyx, Calyceal Diverticula which poses a barrier to clearance of stone fragments.
Certain stone types such as Calcium Oxalate stones and Cysteine stones may be resistent to Shock wave lithotripsy treatment.
Since ureter has a limited capacity to discharge stone fragments so it posed a barrier to efficiency of SWL treatment for stone burden exceeding 2.5 cms.
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