ESWL (Extracorporeal Shock Wave Lithotripsy)

A non-incisional treatment in which urinary tract stones are broken into small fragments using focused shock waves applied through the skin. The fragments are then passed in the urine.

Indication

• Radio-opaque stones of 5-20 mm in the renal pelvis or upper calyces
• Stones smaller than 10 mm in the upper ureter that do not block urine flow
• Small to medium stones that cannot be passed with conservative treatment (fluids, medication)
• Selected cases in patients who are unsuitable for surgery or who prefer minimally invasive options
• Stone types that respond relatively well to shock waves, such as cystine and calcium oxalate dihydrate

Preparation

• Before the procedure, urinalysis, urine culture, blood tests, and imaging (CT or ultrasound) are used to determine the stone's size and location
• Any active urinary tract infection is treated with antibiotics first
• Blood thinners (warfarin, antiplatelets) are stopped 5-7 days before the procedure with physician approval
• If sedation is planned, food and drink are stopped 6 hours before the procedure
• The procedure is not performed in suspected pregnancy; a pregnancy test is requested if needed

How it's performed

1. The patient is placed supine or prone on the device's table; position is chosen according to the stone's location
2. The position of the stone is identified using fluoroscopy (X-ray) or ultrasound guidance
3. A special gel is applied between the skin and the device to transmit the shock waves
4. Under mild sedation and analgesia, 1,500-3,000 focused shock waves are typically delivered
5. Pulse, blood pressure, and oxygen levels are monitored continuously throughout the procedure
6. The total duration is about 30-60 minutes; same-day discharge is usually possible

Post-procedure

• Drinking 2-2.5 liters of fluid daily is recommended for the first 1-2 weeks
• Urine may be passed through a strainer to collect stone fragments for analysis
• Mild flank or back pain and pink-tinged urine for a few days are common and managed with painkillers
• First follow-up is usually in 2-4 weeks; ultrasound or plain X-ray is performed to evaluate stone passage
• If a single session is not sufficient, sessions may be repeated at 2-3 week intervals (usually up to 3 sessions)

Risks

• Temporary skin bruising and tenderness in the treatment area
• Pinkish bleeding in the urine that may last 1-3 days
• Steinstrasse — fragmented stones becoming impacted in the ureter, causing pain and obstruction
• Urinary tract infection, rarely a febrile urinary tract infection
• Renal hematoma (bleeding around the kidney) — rare; the risk increases with hypertension and anticoagulant use
• Lower success rates in very large (over 20 mm), very hard (e.g., brushite, cystine), or lower-pole calyx stones

FAQ

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