A Painful Condition
An estimated 10 million Americans are diagnosed each year with kidney stones - an extremely painful condition marked by severe, sharp pain in the back and/or abdomen. Kidney stones form when waste builds up within the kidneys - the organ that acts as a filter in the body, dissolving chemicals through its filtration process and eliminating waste in the form of urine. Kidney stones are a serious condition and should be treated before they cause damage to the kidneys.
A Painless Treatment
Extracorporeal Shock Wave Lithotripsy - commonly called ESWL or Lithotripsy - is a safe, effective and common treatment for kidney stones. High-energy shock waves are used to crush kidney stones into sand-like particles, which the body eliminates naturally through the urinary tract. The procedure is completely non-invasive (no surgical incisions are required). Shock waves are administered through a water medium, directly over the site of the kidney stone. More than 2 million patients worldwide have been successfully treated with ESWL since it debuted in 1983.
Benefits of ESWL:
Available to almost everyone
More than 95 percent of kidney stone cases can be successfully treated by ESWL. It's not recommended for patients with certain conditions, including pregnancy, bleeding disorders, obstructions below the stone or a non-functioning kidney. Height and weight are factors that affect the type of lithotripsy machine that is used for the procedure.
Following is information on what you can expect once your ESWL is scheduled. It is important to remember, however, that each patient is unique, so your physician may provide you with additional or different instructions. If you have any questions or concerns, be sure to contact your doctor.
A few days prior to the procedure, a nurse will contact you by phone to fully explain the procedure and to answer all questions. All pre-procedure instructions are thoroughly reviewed so the patient feels prepared and at ease.
What to expect before and during the procedure
On the day of the procedure, the patient will meet with the anesthesiologist to determine the best type of anesthesia. Factors that may affect the type of anesthesia include the patient's medical history, weight, and past surgeries. Alternatives include intravenous (IV), general anesthesia or regional anesthesia (epidural and spinal).
After the anesthesia is administered, the patient is positioned on a movable, reclining frame and, depending on the type of Lithotripter machine being used, he or she is lowered into the water bath or is placed on the treatment table in contact with the water cushion.
Two fluoroscopes, or X-ray tubes, located on either side of the Lithotripter are used to produce high resolution images of the stone on a television monitor. Once the stone has been pinpointed, the urologist will administer consecutive shock waves that flow through the water medium and crush the stone. The patient will not feel the shock waves or any pain during the procedure. A typical treatment will average 1,500 to 3,000 shock waves and usually takes about an hour. Throughout the procedure, the urologist will monitor the shattering of the stone at the control panel and the viewing screens on the Lithotripter. The anesthesiologist will closely monitor the patient's comfort and clinical status throughout the entire procedure.
Why do some patients need a Cystoscopy/Stent?
Some kidney stones are more difficult to see on X-rays. A cystoscopy procedure may be required to identify the stone's exact position. Under anesthesia, a scope is inserted through the external opening of the urinary tract. A small, flexible catheter (stent) is threaded up to the level of the kidney or the stone. Contrast dye may be injected through the stent to locate the stone's position. This type of stent functions as a marker of the stone's position. It is usually removed at the end of the procedure.
Stents can also be used to prevent damage to the kidney. When kidney stones are crushed, they have a tendency to clog up the urinary tract as they exit the kidney. A stent, which is a hollow tube, can also be used to allow urine to drain from the kidney as the stone fragments are passed. One end of the stent is coiled in the kidney while the other end is coiled in the bladder. The stent is not visible externally. The urologist will determine when the stent will be removed (typically 1-2 weeks after the Lithotripsy procedure). Since anesthesia is required, the cystoscopy and stent insertion are completely painless and take less than half an hour to complete.
After the Lithotripsy is completed
After the Lithotripsy procedure, the patient is transferred to the Recovery Room for close observation and patient care by nursing staff. Medications may be administered to alleviate discomfort. Patients also receive oral fluids and perhaps a light snack. When fully recovered and comfortable, the patient is ready for discharge home. The nurse reviews all discharge instructions carefully with the patient and family, prior to the family member driving the patient home. Please note: All ESWL patients must have a driver available (or other arrangements made) on the day of the procedure. Following the receipt of anesthetics, no patients will be permitted to operate a vehicle.
The next day, a nurse will contact the patient by phone to check on his or her progress, review any instructions, and answer any questions or concerns. Discomfort or pain can vary from patient to patient after the Lithotripsy procedure. Patients can request oral pain medications. It is not unusual to have blood in the urine, which normally disappears within a few weeks. After Lithotripsy, it is important to drink lots of fluids – at least 8 to 10 glasses per day.
Most patients are instructed to strain their urine for kidney stone fragments for up to 1-2 weeks after the lithotripsy. Any stones that are collected are sent to the laboratory for chemical analysis. Once the type of kidney stone has been determined, the urologist may prescribe medications to prevent new kidney stones from forming. Following a brief recuperation period, most Lithotripsy patients are able to return to work and normal activities within a few days.
Your physician will provide post-treatment instructions imperative to your recovery.