Q1. What is Extra Corporeal Shock Wave Lithotripsy (ESWL)?
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Q2. How is this treatment carried out?
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Q3. What are the advantages of ESWL?
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Q4. Are there any complications for this procedure?
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Q5. Can all stones be cleared with ESWL?
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Q6. Can all patients be treated with ESWL?
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Q7. After ESWL, do I need to come back for further evaluation?
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Q8. Once this stone is treated, can I form a stone again?
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Q9. Is this treatment very expensive?
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| Q1. |
What is Extra Corporeal Shock Wave Lithotripsy (ESWL)? |
| A1. |
Extra corporeal shock wave lithotripsy (ESWL) as the term indicates, are pressure waves that are generated outside the body, which are passed into the body to break urinary stones into small fragments. These fragments may even be as small as grains of sand. Once the stones are broken up into such small fragments, these fragments pass out in the urine stream over a period of time. |
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Q2. |
How is this treatment carried out? top |
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A2. |
The patient is first evaluated for the site, size, location and number of urinary stones. Other tests will also evaluate the function of the kidneys to find out whether the kidneys will be able to push out the fragments, once the stone has been powdered. Tests are also performed to evaluate other associated medical diseases, if any, which may come in the way of utilising this treatment. The patient is then placed on a table. A water balloon, inside which the shock waves are generated, is placed in contact with the body on the side of the stone to be treated.
Using x-ray imaging, the stone is localised and focused upon. Pressure waves are then generated and focused onto the stone – approximately one every second. These pressure waves will fragment the stone. The duration taken for this again depends upon the size and the number of stones to be treated. Generally, the duration is limited to 45 to 50 minutes. If the stone has not cleared, repeat treatments will be administered. |
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| Q3. |
What are the advantages of ESWL? |
| A3. |
The main advantage of this treatment is that open surgery is not required. Apart from minimal discomfort, there is no severe pain and therefore the requirement of anaesthesia is also very minimal. Hospitalisation is also not required most of the time. As a result, the patient can get back to work the next day. |
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| Q4. |
Are there any complications for this procedure? top |
| A4. |
There are no known long-term complications of this procedure. Side effects such as discomfort during the procedure may be present on a few occasions. All patients will experience some amount of bleeding in the urine after treatment. Passage of the fragments down the urinary tube can cause pain, which can be managed by analgesics.
Some patients, however, may need endoscopy and stenting of the ureter to prevent persistent pain. This may require hospitalisation for a day. At other times, a large load of stone powder may get blocked in the urinary tract. This again requires endoscopic intervention. A small percentage (5%) of stones do not get broken by this method and may need other modes of stone removal. |
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| Q5. |
Can all stones be cleared with ESWL? |
| A5. |
All stones definitely cannot be cleared by ESWL. Success rate with stones in the kidneys is much higher than with stones lower down in the urinary tract. Smaller stones have a better success rate than larger stones (stones that are larger than 2 cm). |
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Q6. |
Can all patients be treated with ESWL? |
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A6. |
Pregnant women, patients with urinary infection, uncontrolled diabetes or hypertension, and bleeding disorders, are not candidates for this form of treatment. Similarly, those patients whose kidneys are not functioning will also not benefit from ESWL. For further details, please contact your urologist. |
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| Q7. |
After ESWL, do I need to come back for further evaluation? top |
| A7. |
Yes, you will have to come back after ESWL for further evaluation. The proof of successful completion of the treatment is obtained by performing an ultrasound evaluation and x-rays, in order to confirm the passage of the stones. Sometimes, small 3-4 mm stones may be left behind, which are generally of no consequence. |
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| Q8. |
Once this stone is treated, can I form a stone again? |
| A8. |
Statistics indicate that 50% of all patients with urinary stones are likely to form a stone again. For this reason, certain dietary changes are prescribed for all patients with this condition. This mainly involves increased fluid/water intake, increased dietary fibre, and cutting down on non-vegetarian food and highly carbonated drinks. For this too, your urologist will provide you with the necessary details, depending upon the nature of the stone and associated medical conditions. |
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| Q9. |
Is this treatment very expensive? |
| A9. |
If the stones for this treatment are appropriately chosen, this treatment need not cost any more than other types of treatment. |
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