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Lithotripsy or Extracorporeal Shockwave Lithotripsy (ESWL)

Lithotripsy can treat stones in both the ureter and the kidney and is a popular treatment for those patients who want to be proactive about treating their stones but yet would rather avoid (or are deemed unfit for) a general anaesthetic. 

 

What is Lithotripsy?

Also known as Extracorporeal Shockwave Lithotripsy (ESWL), Lithotripsy is a minimally invasive treatment where no anaesthetic or sedation is required and patients can ‘walk in and walk out’ of hospital the same day within the space of an hour or two.

High energy sound waves are focused on the stone to be treated using Xrays or ultrasound. The sound waves then break the stone into smaller fragments which are then passed out of the body naturally in the urine.

 

What are the alternatives?

Your Manchester Urology stone specialist will discuss the pros and cons of all the treatment options available to you. These may include:

Observation – This is attractive to many patients as it doesn’t expose them to any potential risks associated with intervention. However, this benefit must be weighed against the level of symptoms experienced and the chance of any stones passing spontaneously from their position in the ureter or if they moved to the ureter from the kidney in the future. Not only can stones that block the drainage from the kidney cause pain but poor drainage can predispose to infection or deterioration in kidney function. 

Ureteroscopy - Whilst there are many benefits to Lithotripsy, one of the drawbacks can be that the time to treat stones may be longer. Stones are often successfully treated after a single session however, more commonly it can take more and patients may opt for ureteroscopy (minimally invasive technique under general anaesthesia) which often has similar success rates but in a quicker timeframe. Such benefits are weighed against the fact that, albeit a minimally invasive treatment, it is more invasive than Lithotripsy.

Percutaneous Nephrolithotomy (PCNL) – is often reserved for larger and more complex stones and boasts superior stone free rates in a single treatment session but again requires general anaesthesia and whilst still regarded as a minimally invasive technique, is the most invasive of all the options.  

 

Having decided on Lithotripsy, what can I expect?

Having discussed the procedure in detail with your Manchester Urology stone specialist, you will be given a date to attend for lithotripsy. On arrival, you will be greeted by the hospital staff and asked to provide a urine sample which will be checked for infection. It is therefore helpful to attend with a comfortably-full bladder. Ladies may also be required to have a urinary pregnancy test. Your blood pressure will be checked and then you will be reviewed by one of the Manchester Urology stone specialists and the procedure discussed again and a safety checklist undertaken. 

You do not need to be nil by mouth but a light meal is recommended beforehand and not within 2 hours of the procedure when you should drink clear fluids only.
During the procedure you will be awake and are free to chat to staff or just relax. You will have a sensation like being gently flicked in the back by an elastic band. You may also experience a deeper discomfort in the kidney. The treatment usually takes 30 minutes.

 

What can I expect after the treatment?

After the treatment you blood pressure will be checked. The Manchester Urology stone specialist will give you an initial impression of how the treatment went and you will be given instruction about what to do should you have any problems after the procedure and a provisional plan made for follow up Xrays, scans or further treatment. You will be offered painkillers to take home with you.

 

Are there any side-effects?

Most procedures have possible side-effects. But, although the complications listed below are well-recognised, most patients do not suffer any problems.

Common (greater than 1 in 10)

  • Blood in your urine for a short time after the procedure.
  • Pain in your kidney as small fragments of stone pass (20%).
  • Urinary infection due to bacteria released as the stone breaks (10%).
  • Bruising or blistering of the skin.
  • Need for further ESWL treatment.
  • Failure to break stone(s) which may need alternative treatment, especially for very hard stones.
  • Recurrence of stones (approx 50%).

Occasional (between 1 in 10 and 1 in 50)

  • Stone fragments may get stuck in the tube between the kidney and the bladder; this may require surgery to remove the fragments (approx..5%).

Rare (less than 1 in 50)

  • Severe infection requiring intravenous antibiotics (less than 1%) and drainage of the kidney by a small tube placed into the kidney.
  • Kidney damage (bruising) or infection needing further treatment.
  • Damage to other organs (eg pancreas or lungs) by the shockwaves requiring further treatment.

 

What can I expect at home?

It is your responsibility to make sure you are fit to drive following your surgery. You do not normally need to tell the DVLA that you have had surgery, unless you have a medical condition that will last for longer than three months after your surgery and may affect your ability to drive. You should, however, check with your insurance company before returning to driving.

It is common to see blood in the urine for 48-72 hours after the procedure. It is advisable that you drink plenty of fluids to try and flush the stone fragments and clear the urine. If you develop a fever, severe pain, you cannot pass urine or your bleeding increases, you should seek medical advice immediately. Small blood clots or stone fragments can pass down from the kidney, resulting in kidney pain. This is a sign that the stone is attempting to pass yet it is advisable you seek medical attention if you have intolerable pain despite painkillers or the pain is associate with a temperature.

 

Links:

http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/ESWL.pdf
http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Stone_diet.pdf