ESWL (Lithotripsy)

Figure: Extracorporeal shockwave lithotripsy (ESWL) for kidney and upper ureter stones.

EWSL Lithotripsy (Extracorporeal shock wave lithotripsy) is a technique for treating kidney stones that does not require surgery. It involves the use of high energy shock waves that are passed through the body and used to break up the kidney stones into pieces as small as grains of sand. Because of their small size, these pieces can pass from the body along with the urine.

What are the indications for an ESWL?

Common indications for this procedure include:

• Kidney stones of less than 1.5 cm in size that are visible on X-ray

• Proximal ureter stones that are visible on X-ray

ESWL should NOT be done in patients who are pregnant, have known bleeding problems or take blood thinning medications, have cardiac pacemakers, aortic or kidney aneurysms or an untreated urinary tract infection.

What pre-operative work up is needed?

Your urologist will organise any necessary urine and blood tests and imaging scans (usually a CT scan and an X ray) at your consultation prior to your procedure.

If you take any blood thinning such as aspirin, warfarin, plavix (clopidogrel) and anticoagulants medication, you should discuss with your urologist, as these will need to be stopped temporarily.

Please ensure you return any admission forms given to you to be filled out back to the hospital.

What happens on the day of the procedure?

You may have an X-ray on the day or the day prior to make sure your stone has not moved.

You will be given fasting instructions prior to your admission (usually for 6 hours prior to the procedure). You should bring a list of your medications, any recent scans or reports with you to the hospital. After you are admitted from the admission lounge, your urologist will see you to discuss the surgery. An anaesthetist will see you to discuss the anaesthetic (general) before you are taken to the operation theatre. You may be provided with a pair of TED stockings to wear to prevent blood clots from developing and passing into your lungs.

What does this procedure involve?

After an injection of antibiotics, you are given a general anaesthetic. X-ray is used to target the stone and shockwaves are fired through the skin focusing them down to break kidney stones into small enough fragments to pass naturally. Treatment normally lasts 30 to 60 minutes and you will be discharged later on the same day.

Are there any risks or side-effects of ESWL?

• Blood in your urine for several days 30-40%

• Pain in your kidney as small fragments of stone pass 30-40%

• Infection in your urinary tract 5-10%

• Failure to break the stone needing further treatments to clear any remaining stones 5-15% (depending on stone size and location)

• Bruising / blistering of the skin at the site of shockwave 5-10%

• Fragments getting in your ureter requiring surgical removal 5-10%

• Severe infection requiring injected antibiotics or drainage of the kidney with a stent or nephrostomy 1-2%

• Kidney or adjacent organ damage with severe bruising needing admission, blood transfusion, embolisation or removal of kidney 1-2%

What can I expect on discharge when I get home?

You should drink twice as much fluid as you would normally for the first 24 to 48 hours, to flush any blood and debris out of your system and reduce the risk of infection. 

Most people recover from ESWL quickly; you may return to work after 3-5 days when you are comfortable enough and when your GP is satisfied with your progress.

If you feel unwell, dizzy, develop a fever, get severe pain in the area of the affected kidney or on passing urine, get severe bleeding with clots in your urine or are unable to pass urine, you should go to your nearest emergency department.

What follow-up will I need?

You urologist will see you in clinic in 4-6 weeks with an X-ray and / or CT scan prior.