Lakeshore Urology

ESWL - Extracorporeal Shock Wave Lithotripsy

Extracorporeal Shock Wave Lithotripsy (ESWL) is a treatment used to break up kidney stones. 

ESWL is an outpatient procedure performed at the hospital. An IV is started, and you are given an antibiotic to protect against infection.  You will also be given sedation.  The surgery is most often performed under general anesthesia. 

While you are sedated, the machine is aimed at the kidney stones.  The machine may be in aimed at the flank area or the abdomen, depending on the stone location.  Once aimed, thousands of high intensity shock waves are fired.  This pulverizes the stones into small, hopefully beach sand sized fragments that pass easily in the urine over the next few days. The procedure itself generally takes 20-25 minutes but preparation and recovery time can last hours.  You will go home after the procedure, but will not be able to drive due to the sedation.  There may be some pain while the stones are passing, and your urine will be dark, discolored and you should see stone fragments.  This can last from several days to a week.  You should drink as much water as practical while passing the stones, and you should strain your urine to catch the stone fragments.  Save the fragments and bring them into the office for analysis at your followup appointment.

As with any procedure, there are risks, which include failure, damage to adjacent tissues, bleeding, infection, post procedure discomfort.  You may end up with some bruising at the site where the lithotripter is aimed.

ESWL is the least invasive treatment for kidney stones, and works best with stones between 4mm and 20mm that are located in the kidney.  Stones in the ureters are also successfully treated that are located in the ureters. Lithotripsy can be more than 90 percent successful in one session and can be repeated if the stones do not completely resolve. Factors such as body size, amount of stone burden and location of stones factor into successful treatment outcomes.

Depending on the amount of stone burden or if the ureter is irritated, Dr. Fleming may opt to temporarily place a urinary stent.  This stent is meant to keep urine flowing through the ureter preventing obstruction by the stones "piling up" in the ureter (a complication known as steinstrasse-- german for "stone street").  The stent is completely internal, and is removed in the office after about a week.

Extracorporeal Shock Wave Lithotripsy (ESWL)

Post Procedure Instructions:

You should:

• Increase your fluid intake
  
• Strain your urine until seen in the office and collect the stone fragments. The fragments will look like grains of sand.
  

Restrictions:

• You can work or lift as tolerated
  
• Plan on taking at least two days off from work
  

You can expect:

• Some flank pain and colic like pain as the fragments of stone pass
  
• Blood in the urine
  
• Discolored urine
  
• Some bruising at the procedure site
  

You may have a stent after your surgery, If so you can expect:

• Feelings of urinary urgency and frequency.
  
• There will be blood in the urine as long as the stent is in place. This is normal.
  
• If the bleeding becomes excessive (large clots) you should decrease your activity and increase your fluid intake
  

You should call the office:

• If you develop a temperature of 100.6 or greater
  
• If you are not contacted for a follow up appointment one business day after your surgery
  
• If you have persistent nausea and vomiting or if pain medication is not adequate, Go to the ER
  
• If you develop calf tenderness or swelling, Go to the ER.